Breaking Bad News
© BioMed Central Ltd 2004
Received: 20 October 2004
Published: 8 November 2004
Keywordsbioethics communication critical illness
Even the most skilled physician knows that conveying bad news to a patient or family can be one of the most arduous aspects of health care. Historically, breaking bad news is a skill that has generally been under-emphasized in training programmes. Critical care physicians are commonly faced with the difficult task of breaking bad news, often in dramatic, emotional and unexpected situations. Breaking Bad News is a website designed to provide all health practitioners (not just critical care physicians) with a framework, skills and some practical suggestions on how to approach this situation effectively, efficiently and with compassion. The website is divided into three main sections: guidelines, strategies and resources.
The guidelines section comprehensively covers a large amount of material ranging from the logistics of 'getting started' all the way to 'planning and follow up'. Most of the subsections are also accompanied by one or two exercises, along with an example that emphasizes the intended content of that subsection. The guidelines end with a top 10 'do's and don'ts' portion, which is particularly directed and helpful.
The strategies section focuses predominantly on the aftermath of the patient having received bad news. Small subsections succinctly cover the topics of 'denial', 'collusion', 'anger, guilt and blame', 'grief', 'encouraging hope' and 'answering difficult questions'. Each subsection discusses common scenarios that one could anticipate and possible solutions to those scenarios.
The resources section is a UK directed portion of the website that offers further excellent resources for users. It provides printer ready handouts for patients, as well as the 10 'do's and don'ts' of breaking bad news in a printable pocket-card format. The best part of the resources section is the comprehensive list of more than 25 websites where patients and health care workers may further pursue information about specific hospital programmes, treatment programmes, support organizations and help groups. Targeted at the UK health care community, the resources section, although comprehensive, is limited in its usefulness to the international community.
Breaking Bad News is supported by an unrestricted educational grant from Pfizer.
The user-friendly files that can be downloaded and printed for both patients and health care workers are very useful.
The monochrome colour scheme and small font make the navigation and reading of the site more difficult than it needs to be.
A more comprehensive list of references for the content presented would be a welcome addition.
University of Washington School of Medicine's Breaking Bad News – http://eduserv.hscer.washington.edu/bioethics/topics/badnws.html
This website covers much of the same material as Breaking Bad News. The breaking bad news section is largely referenced to Dr Rob Buckman's six-step approach. There are two cases that accompany the bulk of the content, with helpful and relevant case discussion sections. Furthermore, there are also many references for reading and guidance with regard to breaking bad news. The website also addresses many other 'difficult' topics under the umbrella of bioethics, including how to discuss 'do-not-resuscitate' orders, end of life issues and cross-cultural differences.