How Do You Share Bad News?

Gulp.

You’re project is behind schedule. Funding didn’t get approved for your pet initiative. Contract isn’t going to be renewed. Company is downsizing. The feature you were sure was going to be a hit is a dud. I could go on, but you get the point.

Bad news: Any information which adversely and seriously affects an individual’s view of his or her future.

This feeling of letting down friends, family, coworkers, and bosses can overwhelm you in these moments. Could you have done something to prevent this? Maybe it will affect how others view you. Will this be a scarlet letter that always stays on you?

Maybe you tend to minimize the news. Rationally speaking, it could be worse, after all. I remember my grandfather always hitting me with the cliche of, “hey, at least you have your health!”

Regardless of the tool you use to cope with bad news, it’s even worse to have to pass it on to others. I still remember the first time I had a call a client to tell we weren’t going to meet the original delivery date that was promised. Felt like a worm dangling on a hook that was going to be fired or at least publicly reprimanded by my superiors. I was just a wreck.

It did need to be shared though, and the longer I put it off the worse it was going to get. I needed a way to carefully and confidently pass it on.

Believe it or not, it used to be more difficult.

In the 1950s, doctors communicated poor diagnosis much differently than today. According to the Oncologist, it was considered inhumane for a doctor to disclose such information to a patient.

On an episode of 99% Invisible related to the topic, words like “tumor” or “infection” were preferred by oncologists as opposed to “cancer”. If a patient were to react poorly to the news, it was even encouraged to prescribe a lobotomy for cancer patients. I can remember when I was diagnosed with diabetes. As shocked as I was to hear, I can’t imagine needing a lobotomy to make me feel better.

All of that resonates with as a problem on the mental state of the news sharer as well as the receiver. Perhaps people find it difficult receiving diagnosis, especially if it comes out of nowhere. But what if there’s a flaw inside all of us that doesn’t want to be the one giving the news in the first place?

If I enter a conversation unprepared, without a pragmatic approach to sharing difficult news, I will fail with an alarming rate.

Rob Buckman agrees with me.

As a doctor in the UK, he was often forced to share bad news with patients and wondered why it was so hard. Buckman found an outlet in the form of comedic writing and acting. He participated in several radio and television shows in the 70s (including Monty Python’s Flying Circus) where he found a voice that allowed him to cope with the sometimes grim nature of medicine.

He then saw things in a new light after receiving his own bad news. In 1979, he was diagnosed with dermatomyositis., an autoimmune disease which seriously affected his work and was nearly fatal.

A new perspective was presented to him because he was the one on the receiving end this time. His colleagues remarked in an interview how the doctor trusted him with more information because he was a colleague and a little empathy.

“Rob would recall an especially important encounter with this one of his physicians who told him, ‘it must be awful for you, I am sorry.’ Rob nearly burst into tears and hugged him, because the doctor gave him permission to feel ill.”

This permission empowered Rob to tackle his disease head on. Realizing that the emotional state is just as important to overall health as the physical, he started working on a better way to discuss bad news.

The paper that changed the way doctors spoke to patients.

In a collaboration with MD Anderson, a cancer hospital in Houston, Buckman published a paper in 2000 with Walter F. BaileRenato LenziGary GloberEstela A. Beale, and Andrzej P. Kudelka titled “SPIKES—A Six-Step Protocol for Delivering Bad News: Application to the Patient with Cancer“.

In it, they attributed the struggle with sharing bad news with the doctor’s experience as well as a fear of being perceived as a bad at their job. This creates what they call the “MUM” effect, and can be even more severe if the patient already seems distressed.

Pretty sure that applies to all of our professions, if you ask me.

To combat this anxiety over sharing and receiving bad news, the group came up with an acrostic for speaking to cancer patients: SPIKES:

  • Setting
  • Perception
  • Invitation
  • Knowledge
  • Emotions
  • Strategy and Summary

What stood out to me the most were the middle letters.

Doctors could address the perception of an illness by asking questions like, “When you felt that pain, what did you think was going on?” What an incredible context to provide the patient because it starts with them identifying a correct or incorrect assumption they may have about their body.

Of course, at this point the doctor knows the news that needs to be shared, but the invitation allows the receiver of the bad news the opportunity to welcome it. By asking what they would like to hear about the test results, they have an opportunity to take a step forward with their physician.

At this point, doctors have way more knowledge about an illness than the patient needs to hear. So it’s crucial to give facts, but only in small chunks. Don’t overload the patient. Also, by sharing in small chunks you provide an opportunity to check for understanding along the way. It’s crucial to make sure they are following along when they are distressed.

Finally, the SPIKES method was the first to encourage doctors to name the emotion the patient is expressing. “I can tell from your face this is difficult to hear.” This incorporates Buckman’s insight that he needed permission to feel ill from his doctor. By highlighting this, the processing of these feelings can begin so a plan can be made.

Can you see how this could apply to your conversations at work?

This process highlighted for me the areas of sharing bad news that I struggle with. While SPIKES identifies the perception of the patient, I think it’s also important to call out the perception of the sharer. I must make sure my head is clear of any assumptions by checking both of our perceptions during that stage. Perhaps the receiver understands more than I think, or may have information I didn’t have prior to our conversation.

I think if we incorporated more perception alignment into our conversations, we would find a middle ground sooner. Doesn’t mean we have to agree on everything. Just understand each other better.

What also resonated with me is the allowance to react to emotions in the moment, and a permission to feel however they feel. Granted your bad news receiver may not be getting the news of late stage cancer, but the concept still applies.

The slight tweak I would make to my application is not assuming the emotions are negative. Perhaps bad news is an opportunity for innovation in the midst of adversity. If the emotions aren’t great, though, asking how this makes them feel gives them an opportunity to arrive at them organically.

Think about how this permission from you will positively impact the follow up strategy.

Curious to know if you’ve used a process similar to this for sharing bad news with teams and clients. What insight did you gain?

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2 thoughts on “How Do You Share Bad News?

    1. Yeah, which on its face seemed like a familiar concept to our work. I think what struck me as most insightful was the purposeful process of walking through the conversation with people. I’ve often winged it in those situations and learning all this encouraged me to be more mindful of how I share the news with others.

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