Deliver bad news

At the early registrar level it is expected that a prevocational doctor will have acquired the skills, knowledge and behaviours to competently and empathetically deliver bad news.

This task describes a number of activities, as below, where proficiency should be achievable by the end of PGY3.  The doctor is encouraged to download the key clinical task guidelines and seek the support of his/her supervisor for feedback on performance. 

  • Cancer diagnosis, or non-salvageable situation/futile care
  • Communicate openly with empathy
  • Listen to patient/family
  • Clarify as able
  • Involve consultant when required
  • PGY 1
  • PGY 2
  • PGY 3
  • Collaboration and teamwork
    • Collaborate effectively with other specialist teams involved in the patient’s care
  • Communication
    • Set an appropriate tone for any communication with patients and their families, peers and colleagues
    • Communicate clearly and compassionately when breaking bad news or discussing difficult topics (deterioration, poor prognosis, resuscitation and end-of-life issues)
  • Health advocacy
    • Adapt communication strategy according to the culture, values and beliefs of each patient
    • Work with the patient/family/carers to develop a management plan that addresses the needs and preferences of the patient
  • Judgement and clinical decision making
    • Recognise instances of uncertainty and conflicting values, and able to alleviate their potential impact
  • Leadership and management
    • Demonstrate appropriate self-awareness and insight
  • Medical expertise
    • Provide appropriate aftercare and arrange follow-up for all procedures
    • Identify patients suitable for, and refer to, aged care, rehabilitation or palliative care programs
  • Professionalism
    • Deal with ethical uncertainty and conflicting values; maintain ethical standards
  • Collaboration and teamwork
    • Participate in shared decision-making activity involving patients, families and relevant health professionals, such as development of a care plan noting reference to open disclosure in ‘Communication’ section
  • Communication
    • Use appropriate techniques and support when responding to patients and families in distress, and facilitate consultant involvement early in the process; to include participation in open disclosure discussions
  • Health advocacy
    • Recognise health needs of an individual patient beyond their immediate condition
    • Arrange appropriate support for a dying patient
    • Consider how culture, beliefs and health literacy can affect patient understanding of their care and expectations
  • Judgement and clinical decision making
    • Recognise when advice and guidance is required in development of management plans
  • Leadership and management
    • Recognise stressful situations and know when to ask for help
  • Medical expertise
    • Present common cases effectively to senior medical staff and other health professionals
    • Perform a comprehensive examination of all systems
  • Professionalism
    • Critically reflect on own performance and make an accurate assessment of this
  • Collaboration and teamwork
    • Collaborate effectively with other specialist teams involved in the patient’s care
  • Communication
    • Set an appropriate tone for any communication with patients and their families, peers and colleagues
    • Communicate clearly and compassionately when breaking bad news or discussing difficult topics (deterioration, poor prognosis, resuscitation and end-of-life issues)
  • Health advocacy
    • Adapt communication strategy according to the culture, values and beliefs of each patient
    • Work with the patient/family/carers to develop a management plan that addresses the needs and preferences of the patient
  • Judgement and clinical decision making
    • Recognise instances of uncertainty and conflicting values, and able to alleviate their potential impact
  • Leadership and management
    • Demonstrate appropriate self-awareness and insight
  • Medical expertise
    • Provide appropriate aftercare and arrange follow-up for all procedures
    • Identify patients suitable for, and refer to, aged care, rehabilitation or palliative care programs
  • Professionalism
    • Deal with ethical uncertainty and conflicting values; maintain ethical standards