1. Preparation
Know all the fact before the meeting, find out who the patient want present, and ensure privacy and chairs to sit on.
2. What does the patient know?
Ask for a narrative of events by the patient (e.g. “How did it all start?”)
3. Is more information wanted?
Test the waters, but be aware that it can be very frightening to as for more information (e.g.”Would you like me to explain a bit more?”)
4. Give a warming shot
e.g. “I’m afraid it looks rather serious”-then allow a pause for the patient to respond.
5. Allow denial
Denial is a defense, and a way of coping. Allow the patient to control the amount of information.
6. Explain (if requested).
Narrow the information gap, step by step. Detail will not be remembered, but the way you explain will be.
7. Listen to concerns
Ask “What are your main concerns at the moment?” and then allow space for expression of feelings.
8. Encourage ventilation of feelings
This is the KEY phase in terms of patient satisfaction with the interview, because it conveys empathy.
9. Summary-and-plan
Summaries concerns, plan treatment, foster hope.
10. Offer availability
Most patients need further explanation (the details will not have been remembered) and support (adjustment takes weeks or months) and benefit greatly from a family meeting.
From: Breaking Bad News-A ten step approach by Peter Kaye
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