Physicians can improve their ability to break bad news to parents with sick children by working with persons playing the roles of standardized parents. The program was developed at the Children's National Medical Center in Washington, D.C.


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]



(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.


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