Your Father has Died
The patient's daughter must be informed that her father has died. He was in the hospital, but the death was sudden and unexpected. The physician is not the patient's doctor, and has not met the daughter before.
This is perhaps the most challenging example of breaking bad news because of its finality and its suddenness. Having a well thought out approach to this task allows the doctor to be empathic and supportive even though he has no prior relationship with the patient or the daughter.
What to watch for
This interview might be described as SPIKES without the ‘I’. Because the information must be disclosed, there is not an invitation option. Recall that CONES is the recommended strategy for this kind of news, as it is a variation of SPIKES (without the ‘I’). However, since the physician has never met the daughter, he did spend some time eliciting her perception of her father's status before issuing the warning of bad news.
His use of the narrative approach to explore her perception allowed him to prepare the relative for the bad news by putting the patient's death in the context of the medical events that she had observed. In this way the bad news was made to be more natural, although nonetheless traumatic. It's important to add that at any time had she asked 'has he died' the physician was ready to say ‘unfortunately he has’.
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