| Step 1: Clinician preparation and introduction | - Review all pertinent medical facts, check the patient's name, be aware of any uncertainty about the patient's identity, and know the relationships between the patient and those with whom they will be talking.
- Use a room that is quiet and private and allows family members or other loved ones to express their emotions.
- When meeting with the patient or their loved ones, sit down, make eye contact, and remain open to their concerns.
- Begin by identifying yourself and your role.
- Directly address the patient or key persons.
- Refer to the patient by name.
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| Step 2: What does the patient, or family/loved one, know? | - Ask questions such as: "What do you understand about your illness?" or "What have you been told happened to (name of patient)?"
- If the family/loved one is expecting the worst (ie, death of the patient), they may consider such questions to be a delay or stalling. Be aware of this possibility, and address their immediate needs first.
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| Step 3: How much does the patient, or family/loved one, want to know? | - Ask the patient how much they would like to know.
- Occasionally, family members or loved ones ask clinicians not to tell the patient bad news. Ask them if they are afraid that disclosure will hurt the patient.
- If the patient wants their family/loved one to be informed first, their wishes should be respected.
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| Step 4: Sharing the information | - Give a warning, such as: "I am afraid I have some bad news."
- Use plain language.
- Allow the patient or family/loved ones time to digest the information.
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| Step 5: Responding to feelings | - Be prepared for a range of emotions. Some will turn inward and become quiet, others may rage.
- Seek help, such as a social worker or chaplain, to provide ongoing support.
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| Step 6: Planning and follow-up | - Outline next steps, possibly including hospital admission or discharge, consultation with specialists, chaplain services, or autopsy.
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