Dealing with Death & Dying in Medical Education and Practice
© 2001 Kirsti A. Dyer, MD, MS
AMSA Convention March 30, 2001
ABCDE’s of Delivering Bad News

Advance Preparation 

  • What the patient already know/understand already? 
  • Arrange for the presence of a support person and appropriate family
  • Arrange a time and place to be undisturbed (Hand off beeper!)
  • Prepare yourself emotionally
  • Decide on which words and phrases to use—write a script
Build a therapeutic environment/relationship
  • Arrange a private, quiet place without interruptions
  • Provide adequate seating for all
  • Sit close enough to touch if appropriate
  • Reassure about pain, suffering, abandonment
Communicate Well
  • Be direct - "I am sorry that I have bad news for you."
  • Do not use euphemisms, jargon, acronyms
  • Use the words – "Cancer," "AIDS," "Death" as appropriate
  • Allow for silence
  • Use touch appropriately
Deal with patient and family reactions
  • Assess patient reaction: physiologic responses, cognitive coping strategies, affective responses
  • Listen actively, explore, have empathy
Encourage and validate emotions, Evaluate the News
  • Address further needs: What are the patient’s immediate and near-term plans, suicidality?
  • Make appropriate referrals for more support
  • Explore what the news means to the patient
  • Express your own feelings
Rabow MW, McPhee SJ. Beyond breaking bad news: how to help patients who suffer. WJM 1999;171: 260-263. Available as PDF file at: 

Compilation of resources for this presentation © 2001 Kirsti A. Dyer, MD, MS. Journey of Hearts,