By the end of this learning module, the student will be able to:

• develop a structure for approaching the interview when breaking bad news
• understand the SAD NEWS model in breaking bad news
• understand the related and relevant Medical Council of Canada CLEO objectives and incorporate them into the interview for breaking bad news

CLEO Objectives

2.2.2.3. In transmitting difficult news, provide it by identifying with the patient and/or family, without “hidden agendas” or deceptions, and with respect, acceptance, and understanding.

2.2.2.4. In transmitting difficult news (e.g. end of life decisions, chronic illness, homecare, long-term placement or disability), learn the patient’s situation first, and be willing to participate with patients and/or family in mutually defining and solving problems without arousing in them feelings of inadequacy.

2.2.1.9. In providing difficult news, respect cultural differences, be open-minded and willing to explore alternative points of view, avoid being dogmatic.

3.1.2. Synthesizing information

3.1.2.1. Summarize information for patient at end of segments of the interview to ensure accuracy and comprehensiveness.

3.1.2.1.1. Take into account patient’s expectations.

3.1.2.1.2. Invite patient corrections.

3.1.2.2. Give information in portions that can be digested and check for comprehension, using the patient’s responses as a guide.

3.1.2.3. Ask patient what other information would be helpful and explain.

3.1.2.4. Organize explanation, divide it into discrete sections, and develop a logical sequence.

3.1.2.5. Use concise, easily understood statements and avoid jargon.

3.1.2.6. Relate explanations to patient’s illness framework such as previously elicited beliefs, concerns, and expectations.