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Public·12 Verdant Expert
April Padilla
April Padilla

Breaking Bad

Objective: Quality of breaking bad news can seriously affect the course of disease. A frequently applied guideline is the SPIKES-Protocol that have been designed from the physician's perspective. Little is known about patients' preferences in breaking bad news. Our aim was to develop a questionnaire based on the SPIKES-protocol to detect patients preferences for breaking bad news communication.

breaking bad


Results: The novel questionnaire supported the six SPIKES-components of breaking bad news: Setting, Perception, Invitation, Knowledge, Emotions, and Strategy. Perception and Invitation clustered together to one subscale. Depending on clinical and demographic variables different components were rated as important.

Conclusion: Communication preferences in breaking bad news can be assessed using a SPIKES-based questionnaire. Physicians should improve the setting, share knowledge in all clarity, involve the patients in further planning, and consider demographical variables.

Practice implications: Using SPIKES as a framework can optimize breaking bad news conversations but it seems important to emphasize the individual preferences beyond the six steps and tailor the communication process to the individual.

Breaking bad news to patients is one of the most difficult responsibilities in the practice of medicine. Although virtually all physicians in clinical practice encounter situations entailing bad news, medical school offers little formal training in how to discuss bad news with patients and their families. This article presents an overview of issues pertaining to breaking bad news and practical recommendations for clinicians wishing to improve their clinical skills in this area.

In the past few decades, traditional paternalistic models of patient care have given way to an emphasis on patient autonomy and empowerment. A review of studies on patient preferences regarding disclosure of a terminal diagnosis found that 50 to 90 percent of patients desired full disclosure.4 Because a sizable minority of patients still may not want full disclosure, the physician needs to ascertain how the patient would like to have bad news addressed. Qualitative studies about the information needs of cancer patients identify several consistent themes, but which theme is most important to any given patient is highly variable and few patient characteristics accurately predict which theme will be most important.5 Therefore, the physician faces the challenge of individualizing the manner of breaking bad news and the content delivered, according to the patient's desires or needs.

Physicians also have their own issues about breaking bad news. It is an unpleasant task. Physicians do not wish to take hope away from the patient. They may be fearful of the patient's or family's reaction to the news, or uncertain how to deal with an intense emotional response. Bad news often must be delivered in settings that are not conducive to such intimate conversations. The hectic pace of clinical practice may force a physician to deliver bad news with little forewarning or when other responsibilities are competing for the physician's attention.

Several professional groups have published consensus guidelines on how to discuss bad news; however, few of those guidelines are evidence-based.8 The clinical efficacy of many standard recommendations has not been empirically demonstrated.9,10 Less than 25 percent of publications on breaking bad news are based on studies reporting original data, and those studies commonly have methodologic limitations.

In BREAKING BAD, Walter White (Bryan Cranston) is a Phoenix high school chemistry teacher working a second job to support his wife, Skylar (Anna Gunn), and their teenage son, Walt Jr. (R.J. Mitte), who has cerebral palsy. Desperately hard up for money and constantly put down by those around him, Walt reaches the breaking point when he's diagnosed with inoperable lung cancer. He connects with former student Jesse Pinkman (Aaron Paul) to start making and selling methamphetamines in order to raise money for his struggling family. As the seasons progress, Walt's original intent to provide for his family blurs with greed as he becomes a successful drug lord.

Robert Krulwich: This story, it was just the strange juxtaposition, "All right, I want you guys to go out now and find something that is hot, new, sudden, and just breaking, like a real reporter or bears." (laughter)

Soren: And these days, would you do that bad news? [crosstalk 00:42:25] What I was hoping actually and, uh, was that, I mean, admittedly Molly and Simon's had a little bit of, like, the hurricane that just come in. But what I was really hoping was that somebody was gonna get a solid, rock solid breaking news about bears kind of thing.

"I run in to people all the time who say to me, somewhat tremulously, 'if you kill Kim, you are in trouble!'" adds Gilligan, laughing. "To me that's the headline of this show: the character of Kim Wexler. How much people love her, how much people root for her, how disappointing it is that her character is, for lack of a better phrase, breaking bad." 041b061a72


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