When to tell the individual

  1. Prepare the individual for the possibility of difficult/bad news as early as possible in the diagnostic/testing process.
  2. Plan a consultation for the time when all of the results will be available.
  3. Tell the individual as soon as the final result or diagnosis is available.
back to top

 

Prior to giving the news

  1. Ensure the news is given in person.
  2. Allow enough uninterrupted time in a comfortable place.
  3. Encourage a second person or family member to be present, if appropriate.
  4. Ensure you have the necessary information and appropriate referrals.
back to top

 

When giving the news

  1. Assess the individual’s understanding of their situation.
  2. Define the nature of the session. ‘You’ve come today to get the results …’
  3. Warn of the news and offer reassurance:
  4. ’Unfortunately this is probably not the news you wanted to hear’
  5. ‘You may not hear or remember all that I will tell you’
  6. ‘I will repeat it all later’
  7. ‘You can ask questions’
  8. Provide the news simply and honestly. Use lay terms and avoid euphemisms.
  9. Work at the pace the family can cope with; however, avoid withholding further difficult news to other appointments.
  10. Be aware of the types of reactions individuals experience when receiving the news.
  11. After giving the news, allow silence to allow the individual to absorb and respond to the information.
  12. Work from what the individual knows and understands. At each stage, check understanding.
  13. Be aware of unhelpful self-protection strategies when giving news such as suppression of feeling, authoritarian style, and therapeutic zeal.
  14. Be aware of your own body language, actively listen and avoid closed questions.
back to top

 

Afterward

  1. Express empathy and the ability to help; however, avoid expressions such as ‘I know how you feel’.
  2. Prepare the individual for what they may experience after the appointment, eg a feeling of disbelief, physical reactions, a sense of unreality, an inability to concentrate, sleeplessness, moodiness, increased thoughts about the situation and anxiety.
  3. Provide a structure for the next step. This does not mean making a decision but providing support, another appointment or referral or other plan for the next contact.
  4. Provide appropriate written information, as recall of information presented in consultation is often poor.
back to top