′BREAKS′ protocol for breaking bad news

Abstract

Information that drastically alters the life world of the patient is termed as bad news. Conveying bad news is a skilled communication, and not at all easy. The amount of truth to be disclosed is subjective. A properly structured and well-orchestrated communication has a positive therapeutic effect. This is a process of negotiation between patient and physician, but physicians often find it difficult due to many reasons. They feel incompetent and are afraid of unleashing a negative reaction from the patient or their relatives. The physician is reminded of his or her own vulnerability to terminal illness, and find themselves powerless over emotional distress. Lack of sufficient training in breaking bad news is a handicap to most physicians and health care workers. Adherence to the principles of client-centered counseling is helpful in attaining this skill. Fundamental insight of the patient is exploited and the bad news is delivered in a structured manner, because the patient is the one who knows what is hurting him most and he is the one who knows how to move forward. Six-step SPIKES protocol is widely used for breaking bad news. In this paper, we put forward another six-step protocol, the BREAKS protocol as a systematic and easy communication strategy for breaking bad news. Development of competence in dealing with difficult situations has positive therapeutic outcome and is a professionally satisfying one.

Breaking bad news in clinical setting - health professionals′ experience and perceived competence in southwestern Nigeria: A cross sectional study

“…Other well known structured method of disclosing bad news include the ABCDE (A -Advance preparation; B -Build a therapeutic environment/ relationship; C -Communicate well; D -Deal with patient and family reactions; E -Encourage and validate emotions) five steps model developed by Rabow and Mcphee. [16] and BREAKS (B -obtain Background; R -establish Rapport; E -Explore patient's knowledge; A -Announce a warning; K -Kindling; S -Summarize) protocol developed by Narayanan et al [17] In the native Yoruba African society however, cultural as well as religious beliefs and values do modify the way bad news are broken and received. Traditionally, in this setting, instructions and guidance on life issues (including health-related issues) are often transmitted through oral traditions and folklores.…”

How can Doctors Improve their Communication Skills?

“…Studies have demonstrated that many doctors lack competence as well as confidence in their ability to divulge bad news and there is necessity to provide didactic training [35]. Several protocols have been devised to guide the doctors for imparting this skill [36][37][38]. It is useful to follow a strategic approach as described below while breaking bad news and provide information according to the patient's own knowledge or expectations as well as to condense the emotional turmoil into an effective future management plan in the same setting [36].…”

A Suitable Model for Breaking Bad News: Review of Recommendations

“…Table 1. Among these final studies, six main models or protocols were seen or repeated such as SPIKES, Kay's ten step approach, a 7 step approach for end of life news, PEWTER, BREAKS and "In person, In time" (Buckman, 1992;Kay, 1996;Von Gunten et al, 2000;Nardi et al, 2006;Narayanan et al, 2010;Sobczak, 2013). …”