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AAP Conference Preview: Tips for breaking bad news to patients, parents :

October 7, 2016

Editor’s note: For more on educational sessions and events at the 2016 AAP National Conference & Exhibition in San Francisco, read the preview issue of AAP News Today. To register for the conference, visit

A baby in your care has just been diagnosed with spinal muscular atrophy. How do you tell the parents?

“Most physicians receive little or no formal education in communication,” said Emma Jones, M.D., FAAP, a member of the AAP Section on Hospice and Palliative Medicine Executive Committee.

To help bridge this gap, Dr. Jones and section member Christopher Collura, M.D., FAAP, will present an Interactive Group Forum titled “Breaking Bad News: a Roadmap for Difficult Conversations (I1048),” from 8:30-10 a.m. Oct. 22 at the AAP National Conference & Exhibition.

The session will be applicable to general pediatricians and specialists in any care setting, Dr. Jones said. She encourages trainees to attend.

“We will weave a case study throughout, which begins in the pediatrics clinic and goes to the hospital floor then ICU,” she said.

Dr. Jones and Dr. Collura, neonatologist and palliative care physician

at Mayo Clinic Children’s Center, will present some models for approaching difficult conversations, such as ask-tell-ask and the SPIKES model.   

Ask-tell-ask encourages clinicians to dialogue with patients instead of presenting monologues of information, said Dr. Jones, attending physician, Division of Pediatric Palliative Care, Dana-Farber Cancer Institute.

The SPIKES model is a “talking map” or set of guideposts for a conversation, she said. The model includes six steps: setting up the interview, assessing the patient’s perception, obtaining the patient’s invitation, giving knowledge and information to the patient, addressing the patient’s emotions with empathic responses, and strategy and summary.

“We also utilize talking maps for assessing goals of care and discussing prognosis,” Dr. Jones said.

The presenters will discuss using warning shots or small statements that give the patient or parents a moment to prepare themselves for what is to come. For example, saying, “I have some bad news” or “This was not the result I was hoping for” sets the tone before giving detailed information, Dr. Jones said.

Pediatricians should expect patients and families to be emotional when receiving bad news, and they should address the emotion instead of ignoring it or talking over it.

“We also put a lot of focus on helping people respond to emotion and use empathic language to progress the conversation,” she said.

After learning about approaches to delivering bad news, participants will have a chance to work in pairs or small groups to practice having difficult conversations.

If time allows, the presenters may discuss self-care for physicians who deliver bad news.

“Our approach to self-care is to have a strong interdisciplinary team and help each other to get better and get through it,” Dr. Jones said.

It’s important to recognize that true empathy is physically and emotionally demanding, she added, “and if you do this work well, you will deplete your ‘compassion tank’ and therefore need to have ways to fill it up.”

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