Categories in breaking bad news, with response types [A], [B] and [C] (listed below)
(1) communication skills
(2) content issues
(3) support system
(4) intervention
(5) patient perceptions
Communication skills:
(1) introduces oneself and identifies role in management of child [A]
(2) uses family name of parents [A]
(3) uses first name of child [A]
(4) allows parents to talk and ask questions [A]
(5) listens and allows parents to express their feelings [B]
(6) expresses sympathy and compassion [B]
(7) avoids medical jargon and explains things clearly [B]
(8) uses appropriate body language [B]
Content issues:
(1) asks parents about their understanding of events related to their child's condition [A]
(2) discusses physician's assessment based on information available [A]
(3) discusses prognosis based on physician's assessment [A]
(4) mentions general principles of therapy being administered [A]
(5) discusses likely approaches to therapy in the next 24 hours [A]
(6) leaves some room for hope in the discussion [A]
Support system:
(1) asks about family's support system [A]
(2) asks if there is anything the pediatric intensive care unit can do to help the family through the crisis [A]
Interventions:
(1) stresses that every effort is being made to treat the child [A]
(2) relieves parents of guilt and blame for child's condition [A]
(3) prepares parents for when they see their child [A]
Patient perceptions:
(1) greets parents warmly, is friendly and is never crabby or rude [C]
(2) never talks down to the parents or treats them like children [C]
(3) lets parents tell their story and listens carefully; asks thoughtful questions; does not interrupt while parents are talking [C]
(4) shows interest in parents as people; does not act bored or ignore what they have to say [C]
(5) encourages parents to ask questions, and answers them clearly; never avoids questions and never lectures [C]
(6) uses words parents can understand when explaining the child's condition; explains any technical medical terms in plain language [C]
(7) is the type of physician parents want for their child [C]
Response types:
• [A]: yes or no answers
• [B]: 4-point Likert scale with 1 (below expectations), 2 (at expectations), 3 (above expectations), 4 (outstanding performance)
• [C]: 5-point Likert scale with 1 (poor), 2 (fair), 3 (good), 4 (very good), 5 (excellent)
• The responses can help identify areas for improvement.
