SCA / RCA Flanagan's two approaches to breaking bad news (in brief)

Learn more on our RCA course. https://www.pennine-gp-training.co.uk.... Two common BBN situations requiring different approaches to the consultation. Have a look at our CSA cases and practice BBN in your CSA groups https://www.pennine-gp-training.co.uk... Not expecting bad news or little anxiety around a result  Welcome the patient  Start with the usual open question  Find out why the test was organised  What was said at the time of the test  What has happened since  Find out about them as a person  The warning shot  PAUSE – do not talk until after they do  Succinctly deliver the bad news  PAUSE – do not talk until after they do  Allow time for emotion  Show empathy  Allow time for the bad news ‘to sink in’  Answer any questions they may have, as best you can  Explore SPICE and what happens next  Agree what you and the patient may need to do before review  Arrange review (soon)  Summarise before they go   Very anxious about a result  Welcome  Cue led approach to the opening statement  Patient anxiety around an anticipated result can paralyse the consultation – there will be verbal and non-verbal cues  You need a different approach  You cannot draw out the consultation asking all the background questions  Explain "I can see you are very anxious about the result. Normally I would find out about what lead up to the test and what happened next and find out about you. But I can see you are really worried. Let me give you the result and we can sort that out afterwards."  The warning shot  PAUSE – do not talk until after they do  Succinctly deliver the bad news  PAUSE – do not talk until after they do  Allow time for emotion  Show empathy  Ask any background questions (SPICE)  Agree what you and the patient may need to do before review  Arrange review (soon)  Summarise before they go Category Education