These are NOT my original ideas. They are tidbits I garnered at the American College of Surgeons Clinical Congress in 2022. The sesions was entitled "A Multicultural Primer on Death and Dying: Improving Goals of Care Discussions for Surgical Patients Facing the End-of-Life" (PS 120).

Note: These are NOT universally applicable. Please tailor your conversations for each interaction.

How To Break Bad News

• Fire a warning shot. I'm sorry that I have some bad/ hard news to share with you.

• Reveal the headline. Your son came to the trauma bay after being shot/ being in an accident and I’m sorry to tell you that he died.

• Stop talking and be quiet after the headline.

• Acknowledge and legitimize their response. I recognize how hard this must be for you. Quite honestly this sucks. 

Other Tips and Tricks

• If the situation allows, you can ask the family/ patient how they like to receive information. Do they want blunt facts or generalizations? Is there a designated leader who should be the key individual that information is passed through? Note- this isn't beneficial in all situations, such as breaking the news of a family members death in the trauma bay. 

• Avoid euphemisms and medical jargon.

• Tell me more about that (to encourage them to share emotions).

Handling Negative Vibes

• If you notice tension building, either in yourself or in the room (anger, mistrust, etc), acknowledge it. Can we talk about what’s happening here? Please share your perspective with me on this.

• You can ask permission to share your own take on the issue.

• Try to find common ground- often the well being of the patient.

• Keep the focus on the patient.

Maintaining hope and sharing the truth

• Hope means different things to different people and different things to the same person as they move through their illness.

• It’s not our job to dole out info in a way that maintains hope. It’s our job to explore what hope means to them as we share this information.

• Factors that can increase hope- feeling valued, maintaining relationships, time, humor, realistic goals. Adequate pain and symptom control.

• Factors that can decrease hope. Feeling abandoned, devalued and isolated.

• Don’t say “there is nothing else I can do for you”.

Other Helpful Phrases 

• Are you surprised by this conversation?

• That was really hard for me to say. I can only imagine how hard it was for you to hear.

• What would your loved one say if they could talk to us? [This lifts the decision making burden and can help them feel like they’re advocating for what their family would want].

• If they’re making a decision that conflicts with your guidance? Consider asking “what are you hoping for” or what is leading you to make this decision?"