Overview
Date/time interval
Secondo Semestre (02/03/2026 - 05/06/2026)
Syllabus
Course Objectives
Communication and Consulting and BREAKING BAD NEWS are a methodology and procedure to provide news to citizens patients and sick and their caregivers, which can negatively affect a patient’s vision of the future, however it is an essential skill for doctors. There are a multitude of benefits if doctors can perform this task well and will improve the journey of the disease for the patient. There are several models published including the SPIKES and ABCDE models to help guide the doctor to break bad news effectively. This important skill can be taught through various methods, but the most effective may actually be the observation of a session by senior doctors.
1. Preparation for the bad news session.
It is recommended that before the session, the doctor who will have the role of providing bad news to completely review the case, including previous treatments and results. It is also helpful to note any previous discussions with other healthcare personnel to their family members or friends. The presence of a nurse or caregiver who has been involved with the patient may offer emotional support to the patient. A break-free environment should be Achieved by setting time limits for the session, and also handing over the cell phones or bleeps to colleagues during the duration.
2. Environment/environment preparation.
Ideally the session should be conducted face to face in a private consultation room, away from the rest of the patients.
Doctors should ask the patient if they would like someone else to be present during the session, which could include their family members or friends. The presence of a nurse or caregiver who has been involved with the patient can offer emotional support to the patient. A break-free environment should be achieved by setting time limits for the session, and also handing over cell phones or bleeps to colleagues during the duration.
3. Explore patient knowledge, perceptions and expectations.
The physician should be able to probe the patient regarding what they understand about the condition, their perceptions and expectations using open questions. This way, the doctor is able to identify deficiencies in
information and misunderstandings, and address them in the discussion. It is important to note any unrealistic expectations with treatments or prognoses. Exploring how much information the patient wants to know is also essential
because even though most patients would be receptive and want to know all the available information, some would not be so passionate. Avoiding bad news has been shown to be a valid psychological reaction mechanism in patients with cancer and other health threats.
4. Clear and direct communication to the patient.
All models emphasize the importance of clear communication. The use of medical jargon should be avoided, with profane terms used as much as possible.
Information must be provided in the amount intended by the patient in a clear, truthful and direct manner, avoiding vague terms and phrases that may be misunderstood by the patient later. Any concerns about information that is misunderstood by language barriers should be addressed with the use of professional translators who could be brought in for the session, or fellow health care professionals who can speak the language. The doctor may invite the patient to ask questions for clarity and leave time for important points to absorb allowing breaks and silence.
5. The emotional side of the discussion.
Patients who receive bad news are likely to experience a multitude of emotions such as denial, anger and sadness. By recognizing these emotions through verbal or non-verbal signals, the doctor can recognize and address these concerns. Simple gestures like delivering a fabric, or saying "I see you’re very upset by the news" are effective. Showing empathy towards the patient, the patient is more likely to trust the doctor and become more receptive during the discussion. It also facilitates the progress of the discussion, as a very anxious and upset patient is less likely to want to absorb information than a calm patient.
5. The emotional side of the discussion.
Patients who receive bad news are likely to experience a multitude of emotions such as denial, anger and sadness. By recognizing these emotions through verbal or non-verbal signals, the doctor can recognize and address these concerns. Simple gestures like delivering a fabric, or saying "I see you’re very upset by the news" are effective. Showing empathy towards the patient, the patient is more likely to trust the doctor and become more receptive during the discussion. It also facilitates the progress of the discussion, as a very anxious and upset patient is less likely to want to absorb information than a calm patient.
6. Summary of the session.
It is useful to ask the patient regularly whether he or she has understood the information discussed so far and invite questions. The doctor and patient can then participate in planning ahead of time and share decision making on treatment options and further care. In some cases the sessions may end with unanswered questions or concerns, and in these situations, further sessions with the gain an idea of how much the patient already knows and their expectations. Mental preparation, scripting and anticipation of difficult questions about prognosis and treatment failure are also suggested steps to prepare for the session.
Simple and practical, the protocol meets the requirements of published research on this topic. The aim is to enable the clinician to meet the four most important objectives of the interview to reveal bad news: collecting information from the patient, passing on medical information, providing support to the patient, To encourage the patient’s collaboration in developing a strategy or treatment plan for the future. Doctors, residents, social workers and medical students who have been taught the protocol reported increased confidence in their ability to reveal adverse medical information to patients
Learning outcomes
At the end of this programme, the delegate may:
• Have an understanding of the definition of bad news
• Be aware of the impact of bad news
• Be able to prepare for giving bad news
• Have the techniques to give bad news with compassion and kindness
• Overcome difficulties to achieve effective communication
• Create practical experience scenarios
1. Preparation for the bad news session.
It is recommended that before the session, the doctor who will have the role of providing bad news to completely review the case, including previous treatments and results. It is also helpful to note any previous discussions with other healthcare personnel to their family members or friends. The presence of a nurse or caregiver who has been involved with the patient may offer emotional support to the patient. A break-free environment should be Achieved by setting time limits for the session, and also handing over the cell phones or bleeps to colleagues during the duration.
2. Environment/environment preparation.
Ideally the session should be conducted face to face in a private consultation room, away from the rest of the patients.
Doctors should ask the patient if they would like someone else to be present during the session, which could include their family members or friends. The presence of a nurse or caregiver who has been involved with the patient can offer emotional support to the patient. A break-free environment should be achieved by setting time limits for the session, and also handing over cell phones or bleeps to colleagues during the duration.
3. Explore patient knowledge, perceptions and expectations.
The physician should be able to probe the patient regarding what they understand about the condition, their perceptions and expectations using open questions. This way, the doctor is able to identify deficiencies in
information and misunderstandings, and address them in the discussion. It is important to note any unrealistic expectations with treatments or prognoses. Exploring how much information the patient wants to know is also essential
because even though most patients would be receptive and want to know all the available information, some would not be so passionate. Avoiding bad news has been shown to be a valid psychological reaction mechanism in patients with cancer and other health threats.
4. Clear and direct communication to the patient.
All models emphasize the importance of clear communication. The use of medical jargon should be avoided, with profane terms used as much as possible.
Information must be provided in the amount intended by the patient in a clear, truthful and direct manner, avoiding vague terms and phrases that may be misunderstood by the patient later. Any concerns about information that is misunderstood by language barriers should be addressed with the use of professional translators who could be brought in for the session, or fellow health care professionals who can speak the language. The doctor may invite the patient to ask questions for clarity and leave time for important points to absorb allowing breaks and silence.
5. The emotional side of the discussion.
Patients who receive bad news are likely to experience a multitude of emotions such as denial, anger and sadness. By recognizing these emotions through verbal or non-verbal signals, the doctor can recognize and address these concerns. Simple gestures like delivering a fabric, or saying "I see you’re very upset by the news" are effective. Showing empathy towards the patient, the patient is more likely to trust the doctor and become more receptive during the discussion. It also facilitates the progress of the discussion, as a very anxious and upset patient is less likely to want to absorb information than a calm patient.
5. The emotional side of the discussion.
Patients who receive bad news are likely to experience a multitude of emotions such as denial, anger and sadness. By recognizing these emotions through verbal or non-verbal signals, the doctor can recognize and address these concerns. Simple gestures like delivering a fabric, or saying "I see you’re very upset by the news" are effective. Showing empathy towards the patient, the patient is more likely to trust the doctor and become more receptive during the discussion. It also facilitates the progress of the discussion, as a very anxious and upset patient is less likely to want to absorb information than a calm patient.
6. Summary of the session.
It is useful to ask the patient regularly whether he or she has understood the information discussed so far and invite questions. The doctor and patient can then participate in planning ahead of time and share decision making on treatment options and further care. In some cases the sessions may end with unanswered questions or concerns, and in these situations, further sessions with the gain an idea of how much the patient already knows and their expectations. Mental preparation, scripting and anticipation of difficult questions about prognosis and treatment failure are also suggested steps to prepare for the session.
Simple and practical, the protocol meets the requirements of published research on this topic. The aim is to enable the clinician to meet the four most important objectives of the interview to reveal bad news: collecting information from the patient, passing on medical information, providing support to the patient, To encourage the patient’s collaboration in developing a strategy or treatment plan for the future. Doctors, residents, social workers and medical students who have been taught the protocol reported increased confidence in their ability to reveal adverse medical information to patients
Learning outcomes
At the end of this programme, the delegate may:
• Have an understanding of the definition of bad news
• Be aware of the impact of bad news
• Be able to prepare for giving bad news
• Have the techniques to give bad news with compassion and kindness
• Overcome difficulties to achieve effective communication
• Create practical experience scenarios
Course Prerequisites
In the health field, the term "Counselling" and "Communication" is now very popular and is widely used, causing a lot of confusion about its meaning. It is discussed in numerous meetings, courses and health conferences because the so-called skills of Counselling are considered indispensable in the field of health and immediate, pharmacists, and nurses and psychologists as all health professionals, need to have high-level communication, relational and social skills. IT IS IMPORTANT TODAY TO PROVIDE TOOLS FOR DEALING WITH THE MOST VARIED SITUATIONS IN WHICH A HEALTH PROFESSIONAL MAY FIND HIMSELF, BOTH AND TO ACCUSTOM HEALTH PROFESSIONALS TO WORK IN TEAMS AND TO COLLABORATE IN A COHERENT WAY.The experiences published in international literature are now extensive and significant, supporting the importance of counselling for pharmacists National Health Service, both hospital and territorial. In addition, the gradual shift in recent years from a drug-centred to a clinical oriented activity has inevitably brought pharmacists closer to patients and other health professionals. The patient has some essential needs: he needs to orient himself in the care, to receive information and clear and understandable indications, he needs to express requests, doubts, uncertainties, emotions. For these reasons it must find at its side in the decision-making moments professionals with communicative and relational skills that can not be improvised. This course, in addition to clarifying the meaning of counselling and the need for ad ho c training to implement non-improvised interventions from a relational point of view, The aim is to provide all future professionals with an overview of the basic principles of interpersonal communication-relationship and counselling in general, and more specifically highlights the added value of Counselling to the health profession with particular regard to the most delicate situations such as that of COMMUNICATING BAD NEWS. Through clinical scenarios from simple to increasingly difficult, helped by colleagues and teachers from established locations, will try to involve students in case management by acquiring skills and expertise.
NO PREREQUISITES REQUIRED
NO PREREQUISITES REQUIRED
Teaching Methods
We will use the Didactical Taxonomix methods of Bloom: Bloom.
-lezione
-gioco di ruolo (role play) e students-as-teachers method
-simulazioni
-casi clinici
- Metodo Looking ahead
- Metodo Just-in-time-teaching (JiTT)
-lezione
-gioco di ruolo (role play) e students-as-teachers method
-simulazioni
-casi clinici
- Metodo Looking ahead
- Metodo Just-in-time-teaching (JiTT)
Assessment Methods
-Briefing e discussione con gli studenti
-Feedback dagli studenti
-Audit
-test finale e sperimentazione di OSCE
-Feedback dagli studenti
-Audit
-test finale e sperimentazione di OSCE
Texts
-https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC6440412/
-https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC8368663/
-https://assets.cureus.com/uploads/original_article/pdf/17154/1612428467-1612428462-20210204-18590-1wn7abk.pdf
-http://www.con-fine.it/confine_2017_01/wp-content/uploads/2017/08/SPIKES-The-Oncologist.pdf
- https://www.sipps.it/pdf/algh2005/doc8.pdf
-https://www.toscanamedica.org/la-comunicazione-nella-relazione-tra-medico-e-paziente/
-https://www.bollettinosifo.it/archivio/2976/articoli/29828/
-https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC8368663/
-https://assets.cureus.com/uploads/original_article/pdf/17154/1612428467-1612428462-20210204-18590-1wn7abk.pdf
-http://www.con-fine.it/confine_2017_01/wp-content/uploads/2017/08/SPIKES-The-Oncologist.pdf
- https://www.sipps.it/pdf/algh2005/doc8.pdf
-https://www.toscanamedica.org/la-comunicazione-nella-relazione-tra-medico-e-paziente/
-https://www.bollettinosifo.it/archivio/2976/articoli/29828/
Contents
The course will consist of three main modules:
1) Communication in the clinical medical world and in the operating team and doctor - pharmacist - nurse - psychologist - patient
2) Communication in the pharmacy and in the territory and in the clinic
3) Communication of bad news by individual operators and the team
The module programme will develop the following themes:
Communicative-relational skills and Breaking Bad News Method
Communication: meanings and models
The communicative competence
The pragmatism of human communication.
The Axioms of Communication and Breaking Bad News Method
Verbal and analogue communication
The listening process
Barriers to communication
The counselling
The customer-centred interview
Basic attitudes: congruence or authenticity, unconditional acceptance, empathy
The Roger techniques: questioning skills (investigative abilities), reformulation, phenomenological feedback
The added value of counselling and Breaking Bad News Method in the health care professional (doctor, pharmacist, nurse, psychologist)
Health, regulatory and training counselling
The role of counselling and Breaking Bad News Method in Hospital
The role of counselling and breaking bad news method in the territory and in the clinic
The role of counselling and Breaking Bad News Method in Pharmacy The role of counselling in Pharmacy: direct distribution, adherence, recognition and pharmacological reconciliation
The Teach Back and Prime Questions method
Narrative Medicine
Medical Humanities
Bad news is stereotypically associated with a terminal diagnosis, but family doctors encounter many situations involving giving bad news; for example, the ultrasound of a pregnant woman verifies a fetal death, The MRI of a middle-aged woman the scan confirms clinical suspicion of multiple sclerosis, or polydipsia in a teenager and weight loss prove to be the onset of diabetes.
Why is Breaking Bad News so difficult? There are many reasons why doctors have trouble breaking bad news. A common concern is how the news will affect the patient, and this is often used to justify withholding bad news. Hippocrates advises "to hide most things from the patient while he is being cared for. Give the necessary information with joy and serenity ... without revealing anything of the patient’s future or present condition. For many patients... they have taken a bad turn ... predicting what will come."
How should bad news be communicated?
How can bad news be communicated in a more compassionate and effective way? Rabow and McPhee have developed a practical, comprehensive model, synthesised from multiple sources, using the simple ABCDE mnemonic.
The following recommendations are modelled after the ABCDE mnemonic of Rabow and McPhee, with modifications and additional material from other sources. Although specific situations may preclude the implementation of many of these suggestions, recommendations are intended to serve as general guidance and should not be considered overly prescriptive.
PREPARING AND PREPARING IN ADVANCE
B- BUILDING AN ENVIRONMENT/THERAPEUTIC RELATIONSHIP
C- COMMUNICATE WELL
MANAGING PATIENT AND FAMILY REACTIONS
1) Communication in the clinical medical world and in the operating team and doctor - pharmacist - nurse - psychologist - patient
2) Communication in the pharmacy and in the territory and in the clinic
3) Communication of bad news by individual operators and the team
The module programme will develop the following themes:
Communicative-relational skills and Breaking Bad News Method
Communication: meanings and models
The communicative competence
The pragmatism of human communication.
The Axioms of Communication and Breaking Bad News Method
Verbal and analogue communication
The listening process
Barriers to communication
The counselling
The customer-centred interview
Basic attitudes: congruence or authenticity, unconditional acceptance, empathy
The Roger techniques: questioning skills (investigative abilities), reformulation, phenomenological feedback
The added value of counselling and Breaking Bad News Method in the health care professional (doctor, pharmacist, nurse, psychologist)
Health, regulatory and training counselling
The role of counselling and Breaking Bad News Method in Hospital
The role of counselling and breaking bad news method in the territory and in the clinic
The role of counselling and Breaking Bad News Method in Pharmacy The role of counselling in Pharmacy: direct distribution, adherence, recognition and pharmacological reconciliation
The Teach Back and Prime Questions method
Narrative Medicine
Medical Humanities
Bad news is stereotypically associated with a terminal diagnosis, but family doctors encounter many situations involving giving bad news; for example, the ultrasound of a pregnant woman verifies a fetal death, The MRI of a middle-aged woman the scan confirms clinical suspicion of multiple sclerosis, or polydipsia in a teenager and weight loss prove to be the onset of diabetes.
Why is Breaking Bad News so difficult? There are many reasons why doctors have trouble breaking bad news. A common concern is how the news will affect the patient, and this is often used to justify withholding bad news. Hippocrates advises "to hide most things from the patient while he is being cared for. Give the necessary information with joy and serenity ... without revealing anything of the patient’s future or present condition. For many patients... they have taken a bad turn ... predicting what will come."
How should bad news be communicated?
How can bad news be communicated in a more compassionate and effective way? Rabow and McPhee have developed a practical, comprehensive model, synthesised from multiple sources, using the simple ABCDE mnemonic.
The following recommendations are modelled after the ABCDE mnemonic of Rabow and McPhee, with modifications and additional material from other sources. Although specific situations may preclude the implementation of many of these suggestions, recommendations are intended to serve as general guidance and should not be considered overly prescriptive.
PREPARING AND PREPARING IN ADVANCE
B- BUILDING AN ENVIRONMENT/THERAPEUTIC RELATIONSHIP
C- COMMUNICATE WELL
MANAGING PATIENT AND FAMILY REACTIONS
Course Language
Italian
More information
THE COURSE WILL BE HELD IN ITALIAN AND ENGLISH LANGUAGE
Communicating and talking with a patient or caregiver and breaking bad news are an essential skill for doctors, pharmacists, nurses and psychologists as well as all health care workers, but it is a skill that in many schools receives little formal instruction. This complex communication skill, if well taught, will increase the confidence and effectiveness of the healthcare professional and the team that work in and provide information to the patient. Teaching lessons, small group teaching and role-playing are among the methods used to teach communication skills at the Academy. However, the only method we thought was more effective was to be allowed to sit and watch a real-life bad news session conducted by senior doctors and counselors followed by a debriefing session. We therefore encourage other senior physicians to include medical students and doctors in these sessions to help them better correlate the theory and practical aspects of this skill. We will try to be as practical as possible.
Communicating and talking with a patient or caregiver and breaking bad news are an essential skill for doctors, pharmacists, nurses and psychologists as well as all health care workers, but it is a skill that in many schools receives little formal instruction. This complex communication skill, if well taught, will increase the confidence and effectiveness of the healthcare professional and the team that work in and provide information to the patient. Teaching lessons, small group teaching and role-playing are among the methods used to teach communication skills at the Academy. However, the only method we thought was more effective was to be allowed to sit and watch a real-life bad news session conducted by senior doctors and counselors followed by a debriefing session. We therefore encourage other senior physicians to include medical students and doctors in these sessions to help them better correlate the theory and practical aspects of this skill. We will try to be as practical as possible.
Degrees
Degrees
MEDICINE AND SURGERY
Single-cycle Master’s Degree (6 Years)
6 years
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People
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