Breaking bad news to patients in the emergency department
Intended for healthcare professionals

Breaking bad news to patients in the emergency department

Sarah Powell Advanced clinical practitioner, Royal Free London NHS Foundation Trust, London, England

Why you should read this article:
  • To identify the importance of preparation for autonomous practitioners when breaking bad news in the emergency department (ED)

  • To consider further training to improve autonomous practitioners’ expertise and skill in breaking bad news in the ED

  • To count towards revalidation as part of your 35 hours of CPD, or you may wish to write a reflective account (UK readers)

  • To contribute towards your professional development and local registration renewal requirements (non-UK readers)

Breaking the news of potentially serious and new diagnoses to patients in the emergency department (ED) is a common but challenging aspect of the autonomous practitioner’s role. It is a complex process, requiring expertise and skill. If the news is delivered appropriately there is evidence to suggest a beneficial effect on the patient’s ability to cope, yet there is little formal training available and literature focused on the ED setting is limited. This article aims to guide and prepare autonomous practitioners in the ED to break bad news to patients, including during remote consultations introduced due to the coronavirus disease 2019 pandemic. It identifies the importance of preparation; different approaches to breaking bad news, namely the six-stage SPIKES framework and a case study exploring its application in practice; the range of potential patient reactions and how these can be managed, including the provision of support; and how to involve and communicate with other members of the multidisciplinary team. Suggestions for further training are outlined.

Emergency Nurse. doi: 10.7748/en.2021.e2108

Peer review

This article has been subject to external double-blind peer review and checked for plagiarism using automated software


Conflict of interest

None declared

Powell S (2021) Breaking bad news to patients in the emergency department. Emergency Nurse. doi: 10.7748/en.2021.e2108

Published online: 13 October 2021

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