What communication frameworks are recommended for breaking bad news to patients in primary care?

Recommended communication frameworks for breaking bad news in primary care include:

• Establish a conducive environment: Ensure privacy and a setting that supports sensitive discussion, respecting the patient's preferences and cultural context.
• Use clear, jargon-free language: Avoid medical jargon, use words the patient understands, and confirm understanding through techniques such as teach back.
• Employ patient-centred communication: Use open-ended questions to encourage discussion, maintain eye contact (if culturally appropriate), and position yourself at the same level as the patient to maximise participation.
• Chunk and check information: Break down information into manageable parts, checking understanding after each segment before proceeding.
• Explore patient preferences: Ask how much information the patient wants, how they wish to be addressed, and who they want involved in discussions.
• Provide information in accessible formats: Offer both verbal and written information tailored to the patient's needs, including use of interpreters or communication aids if necessary.
• Include family or carers as appropriate: With patient consent, involve important others in discussions to provide support.
• Use shared decision making: Collaborate with the patient to make decisions based on evidence and their values, ensuring they understand risks, benefits, and consequences of options.

These approaches align with NICE guidance on patient experience, shared decision making, and end-of-life care communication, emphasising empathy, clarity, and patient empowerment in breaking bad news in primary care settings NICE CG138,NICE NG197,NICE NG31.