How to Break Bad News
There are many occupations and situations where you may be called upon to break bad news. It can be a highly stressful time for both the giver and the receiver. Bad news can be thought of as a situation where there is a threat to a person's mental or physical state, or where the choices a person might normally exercise suddenly become limited. Bad news assumes loss. It may be a death, a loss of freedom, news of a terminal illness or perhaps a physical loss or deformity, to name just a few.
The way the news is broken is highly significant and will influence, amongst other things, the decisions the person needs to make regarding the news. Before breaking the news even begins it is useful to know some of the potential barriers. These include age, gender, race and even social status. The place where the news is broken can help or hinder the process of communication. Lack of appropriate training, time constraints, the manner in which the person who breaks bad news responds to emotions, or questions, or lack of a reaction, are all potential barriers. Knowing this can be helpful, as all these issues can help to prepare people for the task of breaking bad news.
There are a variety of protocols and guidelines to assist the process, many of which overlap to some extent. One example comes from the SPIKES approach advocated by Baile and others. SPIKES is an acronym standing for Setting up, Assessment, Agreement, Imparting, Emotions and finally, Summarizing.
The first step (setting up) prompts the person to prepare carefully. For example, finding a room where no interruptions will take place, a comfortable setting where more than one person can be included if this is appropriate. Assessment of the person's perception comes next. In the case of medical patient it might be a case of finding out what they already know and understand of their situation. Not all people want a great deal of information, therefore the agreement stage is the point where the news-breaker establishes how much detail to provide.
As the breaking of bad news requires imparting knowledge and information, this becomes the fourth stage. Most people accept that it can be useful to tell the person to prepare themselves for bad news. Clear and unambiguous language needs to be used in such a way that it does not come across as insensitive or blunt. The person breaking the news may need to repeat the information in small chunks and check that the person has understood. A wide range of emotions can be displayed. Shock, disbelief, anger, fear, apparent indifference and even humor may be used as a response. Most people who break bad news agree that this is the most stressful point in the process. Knowing how best to respond to emotions is one of the most important yet the most difficult of skills. Non-verbal and verbal responses must match. Touch may be appropriate in some cases. The person imparting bad news must show they understand the reason for the emotion and show they are only focused on the other person during that time.
As the news breaking process draws to a close, it is useful to summarize and to strategize for the future. Of course this must match the recipient's readiness to move on.
Beyond this point it can be useful for the person who breaks bad news to seek support themselves. Some experiences are more difficult and traumatic than others, so the provision of friends or some more formal network such as counseling, can be invaluable.
Baile, W.F., Buckman, R., Lenzi, R. (et al) (2000). SPIKES - a six step protocol for delivering bad news: application to the patient with cancer. The Oncologist, 5, 302-11.