Breaking Bad News

A Self-Directed Learning Module


Recall the last time you received bad news. What was helpful for you? What could the bearer of bad news have done to make it easier for you?

Delivering bad news is often difficult for the doctor and the patient. With the bad news, patients are often thrust into a world of uncertainty and anxiety, which is often how medical students feel when they are asked to deliver bad news. It is very helpful to observe an experienced clinician deliver bad news, but this is a time when patients least likely want someone else present.

There has been a lot of research into the best way to deliver bad news and key concepts from patient and physician feedback have been developed. There are a number of different acronyms available to help remember the steps in delivering bad news. They are very similar and it doesn’t matter which you chose to use, as long as you have an approach which covers the main concepts. The aim of this module is to describe the SAD NEWS model. This has been developed based on the SPIKES model, but the SAD NEWS model emphasizes that after the bad news has been delivered, it is important to anticipate the emotional response and wait for the patient to signal that he/she is ready to move on. When the patient is ready to continue, a discussion can ensue and the patient’s concerns can be addressed and questions answered. This module outlines the SAD NEWS steps.