Table 1: Six-point protocol for breaking bad news
Step	Techniques taught
1. Getting the setting right	Using basic communication and facilitation skills Setting up the physical setting of the interview Ensuring privacy Getting the body language right Making eye contact
2. Finding out what the patient knows already	Asking the patient what he or she already knows or suspects (i.e., What have you made of all this? What were you told?) Listening to the way in which the patient describes the situation, noting the vocabulary used and the level of comprehension as well as denial (which is not confronted at this stage)
3. Finding out what the patient wants to know	Obtaining a clear invitation to share information if this is what the patient wants (i.e., by asking questions that begin, Are you the sort of person who . . . ?) Leaving the option to request information open if the patient declines
4. Giving information	Aligning: starting at the level of patient's comprehension and using the same vocabulary Educating: giving information in small chunks and in simple language, and checking regularly to see whether the content is understood
5. Responding to the patient's reactions	Acknowledging all reactions and feelings Using the empathic response technique (identifying emotion and cause of emotion, and responding to show the patient that this connection has been made) Dealing with crying and with anger and other strong emotions
6. Closing	Summarizing the major areas discussed Asking the patient whether there are other important questions or issues that he or she wishes to discuss now Making a clear contract for the next meeting

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