Posted by: Donna Cunningham | April 12, 2011

How to Break Bad News

A guest blog from wikiHow – The How-to Manual That You Can Edit

Donna says: WikiHow is on my startup page, and from time to time I reprint something that is especially helpful. In using the advice on WikiHow, it’s important to remember that the authors are not ncessarily professionals and cannot replace a consultation with a qualified professional if needed.  Nonetheless, these are people who’ve put in plenty of sweat equity on the problem. 

Breaking bad news to someone is never a pleasant task but breaking it at the wrong time or in the wrong way can be even worse, so it’s important to know the best approaches to breaking bad news. The real difficulty (besides the content of the bad news) is that it is just as hard for the person breaking the bad news as it is for the person receiving it.

Whether you’re a professional delivering news about a patient’s illness, financial fortunes, or legal woes, or you’re a friend, family member, or neighbor having to tell someone you know well something bad, this article will provide some methods to help you do this with the least amount of upset for both parties.

Work through your own reaction to the news before preparing yourself to tell someone else. The news may impact you equally badly, or it may disturb you considerably even if it doesn’t impact you directly. It is important for you to be able to have given yourself a chance to recover your feelings before you try to explain things to someone else.

Perhaps have a cup of coffee, take a shower, meditate or do deep breathing for a few minutes, or simply sit in a quiet dark place for some moments to give yourself the chance to pull together. Once you’ve moved past the initial shock, it’ll be less intimidating to tell the other person but it’s important to acknowledge that it’ll still be hard, so don’t feel that you have to be “perfectly resolved” before talking to them; if the bad news also impacts you, that is unrealistic to even attempt. 2

Practice what you’re going to say. This can help you to formulate the words you’d like to use but be prepared to remain flexible and ready to adapt what you want to say to respond to the other person’s cues (see below). 3

Ensure that the physical setting is comfortable and private. The worst thing that you can do is to blurt something out in a public space with nowhere for the recipient to turn or even sit down to cope with the aftermath of hearing it. Choose an area that has somewhere to sit or rest and that has a low likelihood of being intruded upon by other people. Other things to do to improve the environment include:

  • Turn off all electronic distractions such as the TV, radio, music, etc.
  • Pull the blind or curtains if this will improve privacy but don’t shut out too much light if it’s daytime.
  • Shut the door or pull across a screen or other item to create a private space for the two of you. If you think it would be helpful, have a family member or friend also accompany you.

Choose the right time if possible. Sometimes waiting isn’t possible because the news has to be delivered immediately, before rumors or ill-will gets involved. However, if it is possible to delay the bad news until a time when the other person is available and receptive.

In other words, delivering bad news as a person is coming in the door from a day of work or school, or after you’ve just had a huge row with your partner is not likely to be the best of times. While there is not “good” time to tell bad news, there is a point to waiting until a person is not in the middle of arriving or similar.

If the news is of such import and urgency that it can’t wait for a “better time,” just take a deep breath and break in to whatever is going on with something like, “I need to speak with you, Jane, and I’m afraid it can’t wait.”

The sense of urgency can also be imparted over the phone but it is helpful to ask if it’s possible to meet up quickly so that you can share the news face-to-face. If this isn’t possible, or if the person really needs to know now though, you’re best asking the recipient if they’re sitting down as you need to tell them something unpleasant. If you’re worried about how they might cope alone, also suggest that they have someone else in the vicinity for support.

Assess how the recipient of the news is feeling before your delivery of the news. Obviously, they’ll already be alerted that something is up by your request to speak in private and the arranging of the private space. It is also important to find out what the person already knows, in order to avoid repeating things or prolonging an already difficult situation.

This step is important because it will help you to tailor the words and approach you’ll use to initiate the telling of the bad news. Things to look for include whether the other person already seems to have an inkling that something bad is up, the presence of fear, anxiety, or worry, and whether or not this news is going to come from “out of the blue” (like a death in a car accident) or is something inevitable although not yet faced (like failure of a cancer treatment).

Consider what the bad news is. How bad is it? Are you trying to tell someone that their cat died, or that you lost your job? Has a family member or close friend died? If the bad news relates to you (such as you lost your job) the effects will be different than if the problem relates to them (their cat died).

Approach the delivery of the bad news. The words and your style of delivery are dependent on who you are, your relationship to the person you’re breaking it to, and the context of the news. Use cues obtained from the previous step to tailor your delivery method but there are some key things to bear in mind when delivering bad news:

  • Transition: Help the person get ready for unexpected bad news with such phrases as: “I have some sad news to tell you”, “I’ve just received a call from the hospital: there has been an accident and…”; or “I’ve been talking to your specialist and…”, “There is no easy way to say this but…” etc.[1]
  • Narrative: Be gentle, but come right to the point – believe it or not, this is much easier on a person receiving bad news than spending a lot of time beating around the bush. Don’t ramble or make small talk. Provide the story of what has happened (the narrative) to explain the events. Look the person(s) straight in the eye and calmly tell them what has happened. If there has been an accident and someone has died, say so directly, but gently: “I’m so sorry to tell you this; there was a terrible car accident and Michael is dead.” Don’t leave them hanging with things like, “Michael was in an accident.” This drags it out, and is especially horrible if they start asking what hospital he’s in, etc.
  • As you narrate the events, react to the emotions of the other person as they arise by acknowledging and addressing them.
  • Avoid using euphemisms or metaphors when delivering bad news.

Focus on good communications and an empathic response. Even if you don’t gauge the other person’s initial feelings correctly, and you bungle the delivery of the news, the most important part of breaking news is how well you respond to the other person’s emotions. Use the following empathic technique suggested by oncologist Dr. Robert Buckman:[2]

  • Identify the emotion(s) – these could include shock, fear, anger, disbelief, sadness, distress, or a combination of any of these and other emotions;
  • Identify the cause of the emotions – usually this will be the bad news itself but it could be more layered than this, so be mindful
  • Make the connection between the identification of the emotions and the cause, and make it clear to the recipient that you get the connection. Do this by acknowledging their response, such as “This is a clearly a terrible shock” or “I can see that you’re really upset and angry about what has happened”, and so forth. Doing this lets the person know you get their pain or other reaction and that you’ve tied it to the news you’ve just relayed, without passing any judgment, making any assumptions, or trying to minimize their emotions.
  • If they respond with great anger and yell or behave angrily, remain calm but don’t place yourself in a position of being harmed. If they cry, be there to comfort them. If they become violent, seek help immediately.
  • Realize that the recipient may remain silent, letting the news sink in. If they do that, place your arm around their shoulders and simply sit with them in a display of sympathetic solidarity.
  • When comforting the person, keep in mind social and cultural conventions to avoid making the situation worse.

Decide what to do next. It’s all very well delivering bad news but there must be a strategy for after delivery of it. 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 resolve, manage, deal with, or face the results of the bad news. Help to decide how to handle the news. If a person has died, how will the friend or relative cope? If a cat died, how will the owner honor it? If someone lost their job, how will they find a new one?

Perhaps you can offer to take the recipient somewhere, such as visiting a hospital, gathering belongings, seeing a counselor, going to the police, or whatever is needed where your support could be useful.

Make it plain what is likely to happen next, especially with relation to your own involvement. If you’re a doctor delivering bad news about treatment for example, you might outline the next steps for the patient continuing to visit you. Simply letting the person know when you’ll be around or back again to check on them can be a help in and of itself.

Whatever promises you make to assist the person who has received bad news, be sure to follow through on what you’ve said you’ll do.’

Give the person your time where possible, and be accepting of their need to grieve where relevant.

Keep in mind that everyone reacts differently to bad news. Just because they handle something differently than you would is no reason to take the reaction personally or to belittle their emotions.

Make sure that you yourself are prepared enough to break the news. Be in control of your emotions and stay as calm as you can ever be.

Consider “passing-the-buck”. Would the news be better accepted coming from someone else? If a family member died, a pastor or a close friend might be a better person to deliver the news, then it might be wiser to let them deliver it. This is particularly true if you are not really close with the person to whom the bad news is being delivered. There is no shame in passing an unpleasant task off to someone else if it is done in order to help a hurting person.

In many cases, people intuitively know something, if not the whole story. Dr. David Dosa, a geriatrician, says that in his experience there is never a simple way to tell patients they have a disease that will result in death but he says that he is the one “who confirms what they often already know deep inside”.[3]

About the authors: This article is based around the SPINES technique of Dr. Robert Buckman as outlined in: “Deliver Bad News”, p. 112, in Samantha Ettus, The Expert’s Guide to 100 Things Everyone Should Know How to Do, (2004), ISBN 1-74114-586-4. The SPINES technique stands for “Setting (S), Perception (P), Initiating (I), Narrative (N), Emotions (E), and Strategy and Summary (S).”  edits by:Horses4Ever, KnowItSome, Flickety, Dave Crosby (see all).

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Responses

  1. Talk about being on the receiving end of bad news!
    A friend phoned to say there were videos on You Tube from Japan about the nuclear reactor situation that the News is NOT carrying. She said You Tube pulled the videos off because they didn’t want the public getting too excited. Does anyone else know about this?
    Furthermore she said a million people have vacated Tokyo and that the entire country is in a state of shock and misery because the radiation is worse than we are being told. Those able, will evacuate Japan.They are in mourning for their entire country.
    I knew 2 days after the tsunami that we here in Minnesota were effected with radiation ( this was verified by an article that it registered in Massachusetts also) and according to an article I read recently, the plutonium radiation from reactor 3 will hit across the USA today the 11th. Plutonium is much more powerful than uranium radiation.
    I don’t know about you but I want to know so precautions can be taken.
    Also if its really true that Japan will evacuate then something must be done to help those people who want to get out,( but do not have the means) and set up places for them to go. I think it would be better if volunteer families could host families or individuals rather than herding people into make shift camps. This news should NOT be covered up or treated like it isn’t happening!
    Your article here is timely. Thanks Donna.

    • Oh, my! Japan is actually such a small country (a long, thin island) and so densely populated that millions would have to be moved. Donna

  2. Thank you for this Donna, I don’t know how you do it, but you ALWAYS send your posts just at the right time for me….
    I wish more people would think about how they deliver bad news, I can’t tell you how many times I’ve been told someone has died like this;

    ….*****is dead

    No build-up, no ‘setting the scene’, no introduction of ANY sort….just ****** is dead.
    It’s so dis-empowering and makes the news a million times worse.
    I’ve had ‘professionals’ tell me and family members….but luckily not my friends, I think they know only too well that I need some time and space BEFORE I get the news….but it’s true what it says in the article, you do know that it’s happened…
    Thanx again, I needed the reminder so I never do the same myself:)
    xxxxxx

    • Hi, Mary. T’ain’t me that’s so prescient, I swear, it’s WikiHow. I can’t tell you how many times their featured article fits right into the cosmic currents. It’s uncanny. Big fan! Donna

  3. Delivering bad news is never easy. This past year has been difficult, as I’ve suffered quite a few losses: the loss of an aunt, a friend and the family cat. The hardest was telling my daughters that their beloved cat had died. I find the best thing is just to tell the friend, relative, etc. right away. The recipient of the bad news will be in shock and they usually sense by your tone of voice that something is wrong, the best thing to do is offer comforting words, and offer to help them through the difficult time.


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