Deliver bad news | Best Practice, Better Practitioners

At the early registrar level it is expected that a prevocational doctor will have acquired the skills, knowledge and behaviours to competently and empathetically deliver bad news.

This task describes a number of activities, as below, where proficiency should be achievable by the end of PGY3. The doctor is encouraged to download the key clinical task guidelines and seek the support of his/her supervisor for feedback on performance. Updated key clinical tasks will be available soon for download.

Cancer diagnosis, or non-salvageable situation/futile care
Communicate openly with empathy
Listen to patient/family

Clarify as able
Involve consultant when required

Related Competencies:

Collaboration and teamwork

Inform the presence or availability of team members to patients

Communication

Identify and overcome communication barriers that may occur due to a patient’s age, physical impairment, cognitive ability or literacy level

Health advocacy

Consider, and allow for, the impact of social, economic and political factors, as well as culture, ethnicity, sexuality, disability and spirituality, on patient illness and health

Health advocacy

Show respect for patient treatment choices

Leadership and management

Work well with others to gain respect and trust

Medical expertise

Manage common conditions

See extracts from Australian Curriculum Framework for Junior Doctors (ACJD) and New Zealand Curriculum Framework for Prevocational training (NZCF)

Professionalism

Demonstrate empathy, caring and compassion for patients, their families and carers and treat them with dignity and respect

Professionalism

Treat colleagues and other health care workers with respect

Collaboration and teamwork

Participate in shared decision-making activity involving patients, families and relevant health professionals, such as development of a care plan noting reference to open disclosure in ‘Communication’ section

Communication

Use appropriate techniques and support when responding to patients and families in distress, and facilitate consultant involvement early in the process; to include participation in open disclosure discussions

Health advocacy

Recognise health needs of an individual patient beyond their immediate condition

Health advocacy

Arrange appropriate support for a dying patient

Health advocacy

Consider how culture, beliefs and health literacy can affect patient understanding of their care and expectations

Judgement and clinical decision making

Recognise when advice and guidance is required in development of management plans

Leadership and management

Recognise stressful situations and know when to ask for help

Medical expertise

Present common cases effectively to senior medical staff and other health professionals

Medical expertise

Perform a comprehensive examination of all systems

Professionalism

Critically reflect on own performance and make an accurate assessment of this

Collaboration and teamwork

Collaborate effectively with other specialist teams involved in the patient’s care

Communication

Set an appropriate tone for any communication with patients and their families, peers and colleagues

Communication

Communicate clearly and compassionately when breaking bad news or discussing difficult topics (deterioration, poor prognosis, resuscitation and end-of-life issues)

Health advocacy

Adapt communication strategy according to the culture, values and beliefs of each patient

Health advocacy

Work with the patient/family/carers to develop a management plan that addresses the needs and preferences of the patient

Judgement and clinical decision making

Recognise instances of uncertainty and conflicting values, and able to alleviate their potential impact

Leadership and management

Demonstrate appropriate self-awareness and insight

Medical expertise

Provide appropriate aftercare and arrange follow-up for all procedures

Medical expertise

Identify patients suitable for, and refer to, aged care, rehabilitation or palliative care programs

Professionalism

Deal with ethical uncertainty and conflicting values; maintain ethical standards