helps the patient to feel that it is alright to feel like that. Also, if the patient does not feel that you know what they are going through, you may be perceived as insensitive and therefore not much help to the patient.
After this quick overview of communication I will use Robert Buckman's5 six-step protocol for breaking bad news as a framework for the next part of this presentation.
1. First, Buckman emphasises that the physical context is important as I have already outlined. If you know that the conversation is going to be of a serious or sensitive nature in advance, then you may be able to plan an appropriate setting. But the physical context between the health professional and the patient is important in any event. If it is the doctor telling bad news, it may be appropriate to have another member of the health care team present, and it may be appropriate to ask the patient if they would like to have someone else present.
2. Find out how much the patient knows or suspects. Concentrate on what the patient knows about the impact of the illness on his or her future, not about the exact details of the diagnosis. You may use a question such as:
"What did the previous doctors tell you about the illness you have?"
"What did you understand by what the doctor told you?"
When listening to the reply note the factual content of what the patient is saying, the style, and emotional content of their statements. This will help you respond to the
Presentation for the Life Planning Centre in Tokyo, Japan, 23 February 1997,
