Components of Sharing Bad News

Set up the Interview

  • Arrange for private place
  • Protected, uninterrupted time
  • Arrange so everyone can be seated

Determine Participants

  • News giver – knows parents/information best
  • News recipients – tell parents together/support person
  • Include other health care professionals


  • Know parents’/child’s name and gender
  • Review what you want to communicate (may rehearse first 1-2 sentences)
  • Have relevant information available

Sharing the News

  • Introduce yourself
  • Shake hands if appropriate
  • Use of warning phrase
  • Get to point quickly
  • Allow parents time to absorb information
  • Be comfortable with silence
  • Remain present
  • Personalize information
  • Name diagnosis/etiology if possible
  • Acknowledge uncertainty
  • Address prognosis
  • Balance truth with hope

Anticipate Parental Reactions

  • Be prepared for sadness, anger, guilt, blame
  • Allow expression of emotions
  • Respond to emotions when exhibited

Negotiate Plans

  • Give parents choices when possible
  • Treat parents as partners
  • Acknowledge and address barriers

Follow up Meeting

  • Allow parents time to process information
  • Encourage them to write down questions
  • Meet within short time period (minutes, hours, days, weeks)

Physician Self Care

  • Understand own reactions, emotions
  • Sadness, anger, guilt, sense of responsibility
  • Seek colleagues to gain support
  • Essential to avoid burnout