General /

Everyone struggles with breaking bad news, whether on a personal level or in the workplace. Most of us try to avoid the responsibility because of the emotional discomfort we associate with it. If we can feel competent in our ability to deliver bad news in the most effective and compassionate way, we may be less hesitant to do so. Rabow and McPhee’s mnemonic ABCDE ,- (Advance Preparation, Build a Therapeutic Environment/Relationship, Communicate Well, Deal with the Persons Reactions, Encourage and Validate Emotions) was created to assist medical personnel with delivering difficult news, yet it also provides a framework for delivering bad news in other situations.

A – Advance Preparation
Prepare yourself, – not only with the facts of the situation but also emotionally. Often bad news will impact the person delivering the news as well as the person delivering the news. Processing the information and your response may make it easier to convey the information. Determine if you are the right person to deliver the news by considering who the recipient trusts and who is best aware of the facts. Timing is important, but do not unnecessarily delay delivering the news, waiting for the right time (which is unlikely to come). Most bad news gets more difficult to give or hear with the passage of time. The person delivering the news expends more emotional energy by perseverating on the event. However, iIt is important to pick a time when the person is available (physically, mentally and emotionally).

When possible, provide the bad news face – to – face. Arrange for adequate time in a private, comfortable location. You may want to consider using a public place anticipating that the person’s reaction may be minimized in public, but that deals more with your comfort than theirs. Instead arrange for an adequate amount of time in a private location with comfortable seating and tissues (if appropriate). Turn off your cell phone or pager.
Have some idea of what you want to say and how to say it. Make sure you have all the facts straight and anticipate and prepare for questions. Mentally rehearse how you will deliver the news. It may be helpful to put specific details in writing.

B – Build a Therapeutic Environment/Relationship
Assess the recipient’s feelings prior to delivery. Consider how bad the bad news is for the person. When appropriate (and possible) have family or support persons present. Introduce yourself to everyone. Help the person get ready for unexpected bad news by using phrases such as, I’m sorry but I have bad news to share with you.

C-Communicate Well
It is cruel to be “brutally” honest. Compassionate honesty is preferable. Speak frankly, honestly, and compassionately. Avoid euphemisms and jargon, and talk in short, simple sentences. Be gentle but direct and straight forward. Come to the point. If you soften the message, you may run the risk that the full weight of the information is not understood. Do not spend excessive time giving background to lead up to the point of the information. You can always fill in those blanks. It is preferable not to drag out the suspense. Encourage questions. Ask the person to tell you their understanding of what was shared. Write things down, anticipating that the person will not retain much of what is said after the initial bad news. Allow silence and tears. Avoid the urge to talk to overcome your own discomfort. Proceed at the person’s pace and react to the emotions of the other person as the person processes his/her feelings about the news.

D-Deal with the Person’s Reactions
Assess and respond to the person’s emotional reactions. Be attuned to body language and use that to help anticipate the needs of the individual. Be empathetic. It is appropriate to say, I don’t know or I’m sorry. It is less appropriate or accurate to say, I know how you feel. Anticipate the use of coping strategies such as denial, blame, and intellectualization and respond as appropriate given the timing and circumstances. When comforting the person, keep in mind social and cultural conventions to avoid making the situation worse. It is not unusual for you to become emotional and perhaps cry, but be reflective. Are the tears from empathy, a reflection of your personal issues, or manipulation?

E-Encourage and Validate Emotions
Explore what the news means to the person & what support systems are in place. Offer referrals as needed and appropriate. Plan to make yourself available to the person in the future as needed and appropriate. Decide what to do next. Is there a need for a strategy following delivery of the news? Action can help prevent a person from going into a state of paralysis and shock and can give them a sense of being involved or doing something to move on from the news.
Attend to your own needs.

Additional Thoughts Specific to Workplace Situations
• Bad news should never come as a surprise in a workplace situation. Managers should inform employees of their performance on an ongoing basis and of problems within the workplace.
• Do not delay in giving bad news and when possible inform everyone at the same time.
• Do not hide or try to distort the facts and when appropriate take responsibility, if not for the problem certainly for working on a solution.
• Put the information in writing.
• If there is a bright side to the news, identify it and share it.
• Track any plans to address the situation at the time and in the future, plan of correction.
• Treat everyone with respect and dignity.
• If the bad news involves a one – on – one situation it is best to have an additional person in the room to serve as a witness, perhaps someone from the human resource department.

Aaryce Hayes – Mandt Faculty & COO

ref:
Rabow, McPhee, West J Med, 1999; 171: 260-263. B. BUILD A THERAPEUTIC RELATIONSHIP

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