ABCDE (Rabow and McPhee 1999)
A: Advance preparation—set a time, invite patient to include a support person, ask what the patient knows.
B: Build a therapeutic environment/relationship—find a private, quiet place, reassure about suffering and non-abandonment.
C: Communicate well—be direct, avoid jargon, allow for silence.
D: Deal with patient and family reactions—listen actively, explore feelings, express empathy.
E: Encourage and validate emotions—correct distortions, assess the effect of the news, address further needs, arrange follow-up.
BREAKS (Narayanan et al. 2010)
B: Background, know the background of the patient/family and understand the clinical problem.
R: Rapport, build rapport, provide time. For discussion
E: Explore, what does the patient know. Include other family or support with patient’s permission.
A: Announce, give a warning shot, then deliver the news using straightforwardlanguage.
K: Kindling, address emotions.
S: Summarize, give a summary of the session and set up treatment/care plans.
GUIDE (Back 2013)
G: Get ready—gather data, set up a private and quiet location, ask who needs to be at the meeting.
U: Understand—ask the patient what they already know, then listen.
I: Inform—deliver the news in a single sentence, then listen.
D: Deepen—observe and acknowledge emotions; tolerate silence
E: Equip—map out the next steps. Describe treatment options and follow-up.