Breaking Bad News

SJT Textbook: Breaking Bad News

🎥 Video Lesson (YouTube)

🎧 Podcast Lesson (Spotify / Apple / Amazon)

🎯 THE CORE PRINCIPLE

Breaking bad news means sharing information that significantly worsens a person’s view of their future, such as a new cancer diagnosis, treatment failure, or limited prognosis. Done well, it supports understanding, trust and shared decisions; done poorly, it causes confusion, distress and complaints.

Frameworks such as SPIKES help you structure the conversation: Setting, Perception, Invitation, Knowledge, Empathy, Strategy/Summary. The SJT rewards answers that show preparation, honest and clear language, space for emotion, and a realistic plan with safety-netting and documentation.

⚡ HIGH-YIELD ACTIONS (What Scores Points)

1. Arrange a quiet, private space, sit down and minimise interruptions before starting.
2. Check what the patient understands already and how much detail they want to know today.
3. Give a warning shot, then state the core news in plain language without jargon.
4. Pause, allow silence, and acknowledge emotions with empathy rather than rushing to fix.
5. Explore what matters most to the patient and involve those they want present.
6. Outline immediate next steps, options and what will happen in the short term.
7. Provide written information and clear safety-netting (who to contact, when, why).
8. Document who was present, what was discussed, the patient’s reactions and the agreed plan, and inform the wider team.

These options either ignore preparation and privacy, avoid clear communication, or fail to provide support and a plan. High-scoring options use a structured framework, honest plain language, empathy and a documented pathway forwards.

💬 MODEL PHRASES (Use These in SJT Logic)

* “I am afraid this is difficult news. The scan shows that the cancer has spread. I am so sorry.”
* “We can go at your pace and pause at any time. Would you like anyone else to be here with you?”
* “These are the next steps I suggest, and here is who will contact you and when. What questions do you have at the moment?”

Warn • Ask understanding • Respond to emotion • Make plan • Paperwork • Link team • Arrange follow-up • Next steps agreed

📋 QUICK FAQ

Should I use euphemisms instead of the word “cancer” or “dying”?
No. After a warning shot, use clear, everyday language. Euphemisms and jargon can mislead and delay informed decision-making.

What if the patient says they do not want detailed information?
Respect their preference, offer to share later or with a nominated person if they wish, ensure they know who to contact and when, and document the discussion and plan.

Can I break bad news by phone or video?
Face-to-face in a private room is preferred. If it must be remote (for example urgency or geography), ensure privacy, confirm identity, use the same structured approach, allow extra time and arrange follow-up in person where possible.

Should I always have a relative present?
Ask the patient whom they would like present and obtain consent before including others. Do not assume they want family involved.

What must I record afterwards?
Who was present, what information was given, the patient’s understanding and key concerns, decisions made, written materials provided, safety-netting advice and any follow-up arrangements.

📚 GMC ANCHOR POINTS

• Communicate clearly, listen actively, and be compassionate in consultations (Good medical practice 2024).
• Support shared decision-making by explaining options, benefits and risks in a way patients can understand (Decision making and consent).
• Be open and honest if things go wrong, apologise, and explain what will happen next (professional duty of candour).

💡 MINI PRACTICE SCENARIO

A patient attends clinic alone for biopsy results. You have confirmed that the histology shows malignancy. They look anxious and say, “Just tell me straight, doctor, is it bad?”

Best action: Move to a private room if not already there, sit down, check what they understand and how much detail they want, give a clear warning shot and then state the diagnosis plainly, pause to allow emotion, respond with empathy, then outline immediate next steps and follow-up. Document the discussion and inform the relevant team members.
Why: This uses a recognised structure, respects preferences, provides honest information, makes space for emotion and ensures continuity and safety.

🎯 KEY TAKEAWAYS

✓ Use a structured framework such as SPIKES plus documentation and safety-netting.
✓ Prepare a private setting, check understanding and preferences before giving the news.
✓ Give a warning shot, use plain words, then pause and respond to emotion.
✓ Provide a realistic plan, written information, clear contact details and follow-up.
✓ Record the discussion, including who was present, key points, and agreed next steps.

🔗 RELATED TOPICS

* → Active Listening and Empathic Responses
* → Managing Angry or Distressed Patients
* → Communicating with Interpreters and Patients with Additional Needs
* → End-of-Life Decision-Making and Advance Care Planning

📖 FULL PRACTICE QUESTIONS

Example SJT — Best of 3 (8 options; choose three)

You are an oncology registrar in clinic. A CT scan and biopsy have confirmed that a patient’s lung mass is a non-curable malignancy. The patient has attended alone, appears tense and keeps checking their phone. You are running to time but not especially late.

Options:
A. Call the patient in, state “It is cancer and there is nothing more we can do” as quickly as possible, then move on to the next clinic slot.
B. Ask the patient into a private room, sit down, and begin by asking what they understand so far and how much detail they want today.
C. Tell the patient to rebook for another clinic when they can bring a family member, without giving any results now.
D. Give a warning shot that you have difficult news to share, then explain clearly that the scan and biopsy show cancer that cannot be cured, using plain language.
E. Speak in general terms about “abnormal cells” and “shadowing”, avoiding the word “cancer” to soften the impact.
F. Allow silence after giving the news, notice their distress, acknowledge their feelings and offer tissues and time to compose themselves.
G. Outline the immediate plan, including treatment options, supportive care, follow-up appointments and written information, and check what questions they have.
H. Hand the CT and pathology reports to the patient and ask them to read them at home in their own time.

Example SJT — Rank 5 (best → worst)

A 72-year-old patient on the ward has undergone urgent imaging, which shows widespread metastatic disease. You have confirmed the report with the radiologist and discussed with the consultant, who asks you to update the patient later that afternoon. The patient and their partner arrive together on the ward asking for results. The bay is busy and noisy.

Options:
A. Ask the patient’s permission to speak with both of them, take them to a quiet room, check what they understand, warn that the results are serious, explain clearly that the cancer has spread, pause, respond to their emotions, then outline the plan and document the discussion.
B. Tell them at the bedside in the multi-bed bay, keeping your voice low to avoid others hearing, then move on quickly to your next job.
C. Say that you cannot discuss the results on the ward and ask them to wait for the next outpatient clinic in two weeks so the consultant can “explain properly”.
D. Use phrases such as “things do not look good” and “the scan is not what we hoped for” without directly mentioning metastases, then leave them to absorb this alone.
E. Hand them a printed copy of the CT report and tell them they can read it and then ask the nurses if they have any questions.