Deliver bad news

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
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