Breaking bad news to patients protocols: a review study

Breaking bad news to the patients and their family is an important and difficult stage in disease process requiring both verbal and non-verbal skills. Thus, studies in the field of health psychology have provided protocols to explain step by step how to break bad news. These protocols have focused on how to break bad news in various therapeutic fields and different approaches. The diversity of these models can make health professionals hesitate in choosing the right model. The purpose of this review study was to identify the most widely used protocols for breaking bad news, their similarities and differences, and to provide a structure to compare these protocols.

The search for breaking bad news protocols was conducted in Google Scholar and Science Direct databases. Then, the most widely used protocols that were mostly referred to by other studies were identified. Finally, 13 protocols were selected for detailed investigation.

As a result of comparing these protocols, 9 common concepts were find, including: 1- preparation before the session, 2- setting up the proper communicational space, 3- personal evaluation of the patient, 4- evaluation of the patient's environment, 5- approaching the news, 6- exploring the emotions and providing empathic response, 7-talking about treatment plans, 8- investigating support systems, 9- summarizing and concluding the session. Along with these common steps, 47 sub-steps were identified. All these findings were classified altogether in both summarized and extended model. In summarized model the one look table consisting of 9 common concepts and 47 sub-steps was provided. While in an extended table, the contribution of each of 13 investigated protocols in each of the concepts and sub-steps was clarified by detail.

The extended table also highlights the unique features of each protocol, allowing health professionals to choose the most appropriate approach based on the specific needs of the patients and their families. In general, this study reviews and compares the most important protocols of breaking bad news to patients to provide a relatively comprehensive picture of what has been considered in different studies for breaking bad news. Therefore, it provided the summarized and extended models of breaking bad news to health professionals as a practical tool containing common concepts and different sub-steps of the most important protocols. This study emphasizes the importance of a structured and empathetic approach to breaking bad news, which can improve patient satisfaction, trust, and coping strategies.