12 Breaking Bad News

“Bad news isn’t wine. It doesn’t improve with age.”

– Colin Powell

Some veterinary visits are routine. Examples include yearly physical examinations, perhaps with vaccination and parasite testing, and routine pregnancy assessment of dairy cattle. Many veterinary visits are not routine for the owner and can be a source of great anxiety. The ability to break bad news and help clients work through difficult information enhances adherence and strengthens the veterinarian-client relationship. Kurtz^[1] provides the following summary for breaking bad news:

• Preparation
  • Be adequately prepared (have the record and other documentation handy).
  • Minimize the potential interruptions.

• Setting the scene
  • Summarize where the animal is clinically at this time.
  • Set up an agenda for the visit.
• Sharing the information
  • Signpost the news first – “I’m afraid I have bad news.”
  • Assess their understanding and determine how much they want to know.
  • Give information slowly and ensure understanding – chunk and check.
  • Be thoughtful of the words used – do not use medical jargon and present information in the correct frame (“98% chance of surviving the surgery” versus “2% chance of dying during surgery”).
  • Be aware of your non-verbal behavior.
  • Assess the client’s non-verbal indicators and verify them verbally.
  • Give the client time to take in the information.
  • Do not be afraid to show your own emotion.
• Planning and support
  • Make sure all the client’s questions are answered.
  • Identify what will happen next. Negotiate a plan collaboratively with the client.
  • Give hope tempered with realism (“hope for the best while preparing for the worst”).
• Following up and closing
  • Summarize and make one final check for questions.
  • Identify support systems (grief support groups, hospice services)
  • Make written materials available

In human medicine, the model used for delivery of bad news is SPIKES:

– Setting = ensure privacy, comfort, minimal distractions

– Perception = explore the client’s understanding of where things stand

– Invitation = make sure the client is ready to hear what you have to say

– Knowledge = deliver the bad news in stages and give them some warning of the gravity of what’s coming

– E = empathize

– S = summarize and create a strategy to move forward