Table 7 Tools for communication when long-term follow-up is available

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.