How can I assess a patient's readiness to receive bad news during a consultation?

To assess a patient's readiness to receive bad news during a consultation, first establish the patient's current understanding and expectations about their condition and prognosis. This can be done by asking open-ended questions to explore how much they already know and how much information they wish to receive, respecting their preferences and cultural, religious, or social needs.

Ensure the environment is private and conducive to sensitive discussion, maintaining eye contact and positioning yourself at the same level as the patient to facilitate open communication.

Assess the patient's cognitive status and communication needs, including any speech, language, or sensory impairments, and use appropriate communication aids or involve interpreters or advocates if necessary.

Explore whether the patient wants someone important to them present during the discussion and confirm their preferred way of being addressed and communicated with.

Check the patient's emotional state and readiness by inviting them to express any fears, anxieties, or questions they may have about their condition or prognosis, and be attentive to verbal and non-verbal cues indicating distress or reluctance.

Summarise and confirm understanding throughout the consultation to ensure the patient is processing the information and is comfortable to proceed.

These steps help tailor the delivery of bad news to the individual patient's needs and readiness, promoting shared decision-making and supporting their active participation in care.

All these approaches align with NICE guidance on patient experience and communication, particularly in sensitive or end-of-life contexts ¹,².