Communication Of Bad News Research Articles

Advance care planning for patients with cancer and family caregivers in Indonesia: a qualitative study

BackgroundIndividuals’ willingness to engage in advance care planning is influenced by factors such as culture and religious beliefs. While most studies on advance care planning in Asia have been performed in high-income countries, Indonesia is a lower-middle-income country, with a majority of strongly collectivist and religiously devout inhabitants. We studied the perspectives of Indonesian patients with cancer and family caregivers regarding advance care planning by first exploring their experiences with medical information-disclosure, decision-making, and advance care planning and how these experiences influence their perspectives on advance care planning.MethodsWe conducted semi-structured interviews among 16 patients with cancer and 15 family caregivers in a national cancer center in Jakarta and a tertiary academic general hospital in Yogyakarta. We performed an inductive thematic analysis using open, axial, and selective coding. The rigor of the study was enhanced by reflective journaling, dual coding, and investigator triangulation.ResultsTwenty-six of 31 participants were younger than 60 years old, 20 were Muslim and Javanese, and 17 were college or university graduates. Four major themes emerged as important in advance care planning: (1) participants’ perceptions on the importance or harmfulness of cancer-related information, (2) the importance of communicating bad news sensitively (through empathetic, implicit, and mediated communication), (3) participants’ motives for participating in medical decision-making (decision-making seen as patients’ right or responsibility, or patients’ state of dependency on others), and (4) the complexities of future planning (e.g., due to its irrelevance to participants’ religious beliefs and/or their difficulties in seeing the relevance of future planning).ConclusionsCulturally sensitive approaches to advance care planning in Indonesia should address the importance of facilitating open communication between patients and their families, and the various perspectives on information provision, bad news communication, and decision-making. Advance care planning should focus on the exploration of patients’ values, rather than drafting treatment plans in advance.

Bad news communication protocols in health. Limitations, challenges and proposals

Bad news communication is a frequent and difficult task for health care professionals. There are valuable protocols that systematize this task through a series of steps. However, these protocols have important limitations. The objective of this work is to analyze the main shortcomings of the protocols for CMN, according to the available ethical and clinical evidence. An orientation by objectives is recommended, considering that communication of bad news is a contextual process that involves different actors, and that requires reflection and flexibility to determine the best course of action according to the circumstances of each particular case. The importance of affectionate attention for patients and their relatives is highlighted.

237.2: Transplant Procurement Management: 30 Years of International Training Program in Organ and Tissue Donation

Background: The educational project called Transplant Procurement Management (TPM) was launched in 1991 as a specialised program which main goal is to train health professionals in the field of organ donation for transplantation. Since then, 376 courses have been developed in 44 countries training 15575 health care professionals. The objective is to analyse the impact of the training in the donation rates on those countries where the TPM training has been developed nationally as part of a continuous professional development plan. Methods: TPM offer is organized by levels (introductory, intermediate, advanced) and training modalities (face-to-face, online, blended), with a result of tailored-made courses according to each country needs. Its core program goes through the clinical process of donation for transplantation and its methodology combines theoretical sessions with hands-on workshops in small groups, simulations, cases discussion and debate. Special attention is given to innovative tools: for donor detection workshop, a videogame has been developed to practice how to detect and evaluate donors in a virtual hospital; to practice communication of bad news and family interview for donation consent, an immersive experience with virtual reality has been designed. The impact of the training has been measured through a retrospective study that includes the organ donation rates published in IRODaT during the period 2009-2019 in 8 countries and the number of participants registered in our database. Results: The number of participants trained in these countries from 2009 to 2019 has been as follows: China, 1395; Croatia, 166; Iran, 318; Italy, 2268; Portugal, 301; Slovenia, 263; Thailand, 189; UAE, 283. The donation rates in all countries have increased during the period 2009-2019 in the following: China, 108%; Croatia, 99%, Iran, 394%, Italy, 16%, Portugal, 9%, Slovenia, 24%, Thailand, 217%, UAE, 110%. Conclusions: An increment of the donation rates has been demonstrated in all countries of the study being higher in those countries with lower initial rates. Therefore, TPM courses have been proven effective in those countries with a national strategy to increase the donation activity that includes education. Education is, among other factors, crucial in the development of donation and transplantation systems at regional or national level. Throughout these 30 years TPM has contributed to the professionalization of health professionals involved in this development and will keep on this endeavour.

EMPATIA: A Guide for Communicating the Diagnosis of Neuromuscular Diseases.

Introduction: Neuromuscular diseases comprise a heterogeneous group of genetic syndromes that lead to progressive muscle weakness, resulting in functional limitation. There is a gap in the literature regarding the communication of the diagnosis of such diseases, compromising the autonomy of patients and families, besides causing stress on the assistant physician. Objectives: Developing a guide to reduce communication barriers in the diagnosis of neuromuscular diseases. Methodology: Systematic review, after searching the descriptors (“Muscular Diseases” OR “Neuromuscular Diseases”) AND (“Truth Disclosure” OR “Bad news communication” OR “Breaking bad News”) in the Pubmed, Bireme, and Scopus websites, and these results were analyzed through narrative textual synthesis. Results: 16 articles were submitted to the final analysis, giving rise to seven steps to support the communication process. These are Empathy, Message, Prognosis, Reception, Time, Individualization, and Autonomy. Discussion and conclusion: The empathic transmission of the message and the prognosis must accommodate the feelings of the interlocutors with different information needs. In this way, communication planning optimizes the time and individualizes each context, respecting the autonomy of those involved. EMPATIA reflects the bioethical and interdisciplinary analysis of the literature and comes to fill the gap related to the communication of bad news in neuromuscular diseases.

Communicating bad news in the practice of nursing: an integrative review.

ABSTRACTObjective To analyze current scientific knowledge about communication of bad news by nurses.Methods This is an integrative literature review carried out by searching articles published in national and international journals indexed at SciELO, MEDLINE® (PubMed®), Scopus, Bireme and CINAHL, from 2010 to 2020, by crossing the controlled descriptors “communication”, “revelation of the truth”, and “nursing”, and the uncontrolled descriptor “bad news”.Results Ten articles with qualitative and cross-sectional design, as well as case reports were included. The analysis indicated the evidence available in the literature showed the nurses’ lack of ability to communicate bad news, although they are professionals who have close contact with patients and families and who establish a strong bond with them, and often face challenging situations for communicating bad news.Conclusion There is an evident need to invest in training of nurses on skills to communicate bad news and establish a nurse-patient bond when dialoguing with the family. There are few studies in the literature addressing this issue; therefore, it is recommended to perform research that can contribute to improvements in the clinical practice and developing protocols to promote such care.

Behavioral Patterns in Breaking Bad News Communication: An Ethnographic Study with Hematologists.

Hematologists adequately disclosing bad news is a critical point precluding patient-centered communication. Specific courses on communication for hematologists seem to be rare, as well as research exploring their communicative skills and patterns. We aim at describing the hematologists’ behavior during difficult conversations to account for behavioral patterns in communication and provide new insights regarding teaching skills to communicate bad news. We employed a focused visual ethnography to answer the following research: “what are hematologists’ behavioral patterns in communicating bad news to patients and families?” The collected data included (1) video recordings, (2) observational field notes, (3) interviews with hematologists. The analysis highlighted four patterns: (1) a technical-defensive pattern, (2) an authoritative pattern, (3) a relational-recursive pattern, and (4) a compassionate sharing pattern. Hematologists seem to have difficulty expressing compassionate caring and empathetic comprehension. Communication skills remain a challenge for hematologists. The study of behavioral patterns can lead to increasingly targeted training interventions for this specific learner population.

Death and dying of newborns and children: relationships between nursing and family according to Travelbee.

Identify the nursing staff's perception of their relationship with families of newborns and children who are in the process of death and dying. Qualitative research, carried out in the Neonatal and Pediatric Intensive Care Unit of a public maternity hospital in Rio Grande do Norte, with 17 nursing professionals, through a semi-structured interview. After being transcribed, the data were subjected to Bardin's content analysis and interpreted in the light of the theory of Interpersonal Relations proposed by Travelbee. Four categories emerged from the analysis: "Caring and welcoming people, feelings and stories"; "Reactions in the midst of pain: moving between acceptance and suffering"; "Communication of bad news: challenges and strategies"; "The weight of caring and suffering". Family assistance can be established using Travelbee's principles, as they offer timely theoretical support for nursing actions in the context of the process of death and dying.

Communication of bad news in the context of neonatal palliative care: experience of intensivist nurses

To know the experiences of nurses in neonatal intensive care units in the face of the process of communicating bad news to the family of newborns in palliative care. Study with a descriptive qualitative approach, in which 17 professionals participated. Data were collected through a semi-structured interview script, from December/2018 to February/2019, and submitted to content analysis. Four theoretical categories emerged, with 11 subcategories inserted: meanings attributed to bad news; nursing as a support for the family; difficulties in dealing with the process of communicating bad news; nursing and involvement with the family's suffering. The challenges to deal with the situation are related to lack of preparation, impotence, and subjectivities. The results broaden knowledge on the subject and enable the improvement of nursing care in this context.

Da técnica à tékhnē: comunicação de notícias difíceis em unidade de terapia intensiva pediátrica

ABSTRACT Objective to understand the perceptions of family members of children hospitalized in the Pediatric Intensive Care Unit regarding the communication of bad news. Methods this is a phenomenological study with 15 family members of children hospitalized in the Pediatric Intensive Care Unit of a public university hospital in the state of São Paulo. Interviews were carried out from October 2018 to March 2019. The discourses were understood grounded Heidegger’s existential phenomenology. Results two ontological categories emerged: The child’s family member existing in an inappropriate world; and The child’s family member glimpsing the essence of technology. Family members receive difficult news from health professionals in the instrumentality, emerging the need to extrapolate the technology in search of its essence. Conclusions and implications for practice the discourses reveal that modern technology overlaps with traditional ontology, since health professionals, when communicating difficult news, move away from the being and lose their essence. Health professionals’ improving interpersonal and communication skills can extrapolate the technical dimension, prevalent in intensive care.

Communication of bad news in the medical work: a look at the patient with poor prognosis

Resumo O processo de comunicação é central na relação médico-paciente. É fato que para evitar distanásia deve se dispor dos cuidados paliativos como alternativa. Assim, objetivou-se avaliar a qualidade da comunicação de más notícias realizadas por médicos, na perspectiva de pacientes em processo de finitude, comparando seus índices entre aqueles em cuidados paliativos e em distanásia. Realizou-se uma pesquisa quantitativa, com amostra não probabilística, formada por 234 pacientes com câncer em processo de finitude, oriundos de cinco unidades hospitalares do Ceará, que responderam a dois questionários - um biodemográfico e outro de avaliação da comunicação, analisados por meio de estatística descritiva e bivariada. Os resultados demonstraram a importância da relação médico-paciente. Enquanto os pacientes em distanásia expressaram terem sido melhor preparados para o estabelecimento de uma adequada comunicação, os que estavam em cuidados paliativos relataram uma experiência menos negativa em relação à ‘comunicação de más notícias’ - fruto de um adequado preparo do médico paliativista, bem como da participação efetiva da família na decisão terapêutica. Conclui-se que as etapas de preparação para a comunicação, transmissão da informação, acolhimento e fechamento devem estar baseadas na identificação do conteúdo prévio dos pacientes sobre a doença e suas expectativas de informação.

Comunicação de más notícias na perspectiva de médicos oncologistas e paliativistas

Abstract: Introduction: Communication is essential to medical practice; however, it is constantly performed inadequately, mainly in the context of communicating bad news. The bad news is that it causes a negative change in the patient’s life, resulting in an unpleasant change and modifying his future perspective. In Western medicine, due to the predominance of the curative model, bad news is understood as failure or incapacity of professional competences, causing physicians to distance themselves and causing patient dissatisfaction. Given these circumstances, the SPIKES, P-A-C-I-E-N-T-E, and Class communication protocols emerged. Objective: To evaluate the dynamics of bad news, with respect to the use of specific protocols and the main difficulties experienced, as well as to identify the influence of communication on the doctor-patient relationship. Method: This is a descriptive study with a qualitative methodology, using a semi-structured interview script prepared by the authors. Twelve interviews were carried out with physicians from the Oncology and Palliative Care sectors of the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), which were recorded and transcribed for further analysis. The data was categorized according to Minayo’s proposal. Results: The approach to bad news was very similar among professionals, regardless of the use of communication protocols, with SPIKES being the best known among them. The study revealed that the main difficulties faced by physicians when communicating bad news are related to the environment and time of consultation, high patient demand, doctor-patient-family bond and the medical feeling of not meeting expectations or being frustrated by the experienced situation. A clear influence of communication on the doctor-patient relationship was also identified. The need to update the curriculum of medical schools, including theoretical-practical training in communicating bad news, was also verified. Conclusion: The use of bad news communication protocols is not presented as an essential condition for effective communication; however, it allows greater assertiveness and clarity during the conversation. Therefore, the implementation of communication strategies in the health context is suggested, allowing improvements for both professionals and patients.

Medical student empathy and breaking bad news communication in a simulated consultation

ObjectivesThis study examined the relationship between self-reported empathy and breaking bad news (BBN) communication skills performance in a sample of undergraduate medical students (n = 100) in the clinical years of their program. MethodsCorrelational and regression analysis examined the relationship between Jefferson Scale of Physician Empathy (JSPE-S) and Empathy Quotient (EQ) scores, and communication skills performance based on students’ application of the SPIKES protocol to a BBN scenario in a simulated encounter. ResultsHigher BBN communication skills performance was positively correlated with scores on the “Social Skills” EQ sub-scale (r (99) = 0.31, p = 0.002), which measures spontaneous and context-independent use of social skills. Multiple regression confirmed that “Social Skills” sub-scale variation predicted BBN score variation (B = 2.17, 95% CI = 0.65–3.69, p < 0.01). A weak positive association was also observed between BBN score and the “Standing in Patient’s Shoes” JSPE sub-scale (r (99) = 0.22, p = 0.03). ConclusionsFindings suggest that specific aspects of dispositional empathy may moderate BBN communications skills competence in medical students. Practice implicationsA better understanding of the moderating role of personality may lead to more tailored BBN communications skills training interventions and improved transfer of skills to workplace settings.

Roleplay as an Educational Strategy in Palliative Care: A Systematic Integrative Review.

Simulation activities, such as roleplay, have become established in undergraduate and graduate education in several subjects of healthcare. The objective of this study was to synthesize the evidence available in the literature on the use of roleplay as an educational strategy in palliative care. Using the method proposed by Whittemore and Knafl, this integrative systematic review was carried out based on the following guiding question: "What is the available evidence in the literature on the use of roleplay as an educational strategy in the teaching of palliative care?" The databases used for the selection of articles were the following: Web of Science, Scopus, Cochrane Library, PubMed, CINAHL, EMBASE, and LILACS. There were no limitations regarding the year of publication or language. The articles (n = 34) were grouped into 3 categories, according to the purpose of roleplay use: 1) Use of roleplay as an educational strategy to teach communication in palliative care; 2) Use of roleplay as an educational strategy to teach the communication of bad news, and 3) Use of roleplay as an educational strategy to teach end-of-life care. Roleplay has been employed in the teaching of palliative care in order to develop skills related to communication and to the provision of end-of-life care. These educational activities have mainly been directed to healthcare students and professionals. Future investigations should further evaluate the efficacy of this teaching strategy, based on studies with more robust designs that allow the establishment of cause-and-effect relationships.

Italian onco-haematological patients\u2019 preferences in bad news communication: a preliminary investigation

BackgroundThe manner in which bad news is communicated in oncological contexts can affect patients’ engagement, their coping strategies and therapeutic compliance. Although this topic has been broadly investigated since the nineties, to the best of our knowledge, little has been written about Italian patients’ experiences and preferences concerning what the oncologists should disclose and how they should intimate patients about their health conditions in different stages of oncological disease.MethodsIn an attempt to fill this gap, an online self-report questionnaire was administered to a sample of Italian onco-haematological patients. Data were analysed both qualitatively (by a content analysis) and quantitatively (by descriptive analysis and Generalized Linear Mixed Model).ResultsWhile the majority of patients elected to know the truth during their clinical course, a polarisation between those arguing that the truth be fully disclosed and those claiming that the truth be communicated in a personalised way was observed at the attitude level. Among demographic variables accounted for, age seems to most affect patients’ preferences. Indeed, younger Italian patients decidedly reject concealment of the truth, even when justified by the beneficence principle. This result could be a reaction to some protective and paternalistic behaviours, but it could even reflect a relation according to which the more the age increases the more the fear of knowing rises, or an intergenerational change due to different ways of accessing the information. The qualitative analysis of the final open-ended question revealed three main sources of problems in doctor-patient encounters: scarcity of time, absence of empathy and use of not-understandable language that makes it difficult for patients to assume a more active role.ConclusionsThe results of the present study, which represents a preliminary step in the subject investigation, will be deployed for the construction and validation of a more sophisticated questionnaire. Better awareness of the Italian onco-haematological patients’ preferences concerning bad news communication and truth-telling could be useful in adopting more suitable medical practices and improving doctor-patient relationships.

Development and validation of The Breaking Bad News Attitudes Scale

BackgroundCommunication of bad news plays a critical role in the physician-patient relationship, and a variety of consensus guidelines have been developed to this purpose, including the SPIKES protocol. However, little is known about physicians’ attitudes towards breaking bad news and to be trained to deliver it. This study aimed to develop and validate a self-report questionnaire to assess physicians’ attitudes towards principles of the SPIKES protocol and training on them.MethodsThe Breaking Bad News Attitudes Scale (BBNAS) was administered to 484 pediatricians and 79 medical students, recruited at two scientific conferences and two medical schools in Brazil. The questionnaire structural validity, reliability, and associations with other variables were tested.ResultsThe BBNAS showed adequate validity and good reliability, with two factors measuring attitudes towards the SPIKES strategy for braking bad news (α = 0.81) and the possibility to be trained on it (α = 0.77), respectively.ConclusionThe novel questionnaire is a psychometrically sound measure that provides information on physicians’ agreement with the SPIKES protocol. The BBNAS can provide useful information for planning training and continuing education programs for clinicians on communication of bad news using the SPIKES as a framework.

Communication of bad news in relation with surgery or anesthesia: An interdisciplinary simulation training program

IntroductionDisclosure of damage related to care is a difficult area of communication due to the physician’s feeling of guilt or the fear of liability. The aim of this study was to develop, and to evaluate the impact of an inter-disciplinary simulation program on communication of damage related to care. MethodsResidents in gynecology/obstetrics and anesthesiology participated in role-playing scenarios of communication of damage related to care. We assessed verbal, non-verbal communication skills and inter-disciplinary relations with a modified SPIKES protocol and with a video analysis with predefined indicators. We evaluated long-term impact of the training at 3–6 months with combining self-assessment and a video analysis on retained knowledge. ResultsWe included 80 residents in 15 sessions of simulation. Satisfaction regarding the simulation training was high (9.1/10 [8.9–9.3]). The part of the SPIKES protocol “setting up the interview” was the more difficult to apply. Empathic attitude was adopted 80 % of the time in the two scenarios with a life-threatening complication but was less common in the anesthetic one (broken tooth). The residents found interdisciplinary disclosure helpful due to support from the other resident. Immediately after the session, residents reported an important improvement in communication skills and that the session would significantly change their practice. At 3–6 months, reports were still largely positive but less than on immediate evaluation. ConclusionResidents did not master the most important communication skills. The interdisciplinary method to breaking bad news was felt useful.

Communicating Bad News: Using Role-Play to Teach Nursing Students.

Receiving bad news can have a profound impact on a patient's physical, psychological and social well-being. Therefore, communication of bad news is an essential skill required for health professionals. A good interpersonal relationship based on trust, empathy, and respect can help the psychological adjustment to end-of-life losses. This study presents a simulation-based learning experience designed to teach communication skills to nursing students who care for palliative patients and their family members. The authors suggest adopting Gibbs’ reflective cycle during structured debriefing that enables the students to move logically through the reflective process. A student-centered learning approach can promote responsibility and success in achieving the expected learning outcomes.

Covid-19 pandemic lessons: uncritical communication of test results can induce more harm than benefit and raises questions on standardized quality criteria for communication and liability

ABSTRACT Background The COVID-19 pandemic is characterized by both health and economic risks. A ‘safety loop’ model postulates risk-related decisions are not based on objective and measurable risks but on the subjective perception of those risks. We here illustrate a quantification of the difference between objective and subjective risks. Method The objective risks (or chances) can be obtained from traditional 2 × 2 tables by calculating the positive (+LR) and negative (−LR) likelihood ratios. The subjective perception of objective risks is calculated from the same 2 × 2 tables by exchanging the X- and Y-axes. The traditional 2 × 2 table starts with the hypothesis, uses a test and a gold standard to confirm or exclude the investigated condition. The 2 × 2 table with inverted axes starts with the communication of a test result and presumes that the communication of bad news (whether right or false) will induce ‘Perceived Anxiety’ while good news will induce ‘Perceived Safety’. Two different functions (confirmation and exclusion) of both perceptions (Perceived Anxiety and Safety) can be quantified with those calculations. Results The analysis of six published tests and of one incompletely reported test on COVID-19 polymerase chain reactions (completed by four assumptions on high and low sensitivities and specificities) demonstrated that none of these tests induces ‘Perceived Safety’. Eight of the ten tests confirmed the induction of ‘Perceived Anxiety’ with + LRs (range 3.1–5900). In two of these eight tests, a −LR (0.25 and 0.004) excluded the induction of ‘Perceived Safety’. Conclusions Communication of test results caused perceived anxiety but not perceived safety in 80% of the investigated tests. Medical tests – whether true or false – generate strong psychological messages. In the case of COVID-19 tests may induce more perceived anxiety than safety. Risk communication has to balance objective and subjective risks.

BREAKING BAD NEWS: STRENGTHS, DIFFICULTIES AND STRATEGIES USED BY UNDERGRADUATE NURSING STUDENTS

ABSTRACT Objective: identify strengths, difficulties, and strategies used by nursing students to communicate bad news within the Primary Health Care context during the undergraduate program. Method: exploratory-descriptive study addressing 12 students attending the 7th to the 10th semesters of the nursing undergraduate program of a federal university located in southern Brazil. Their perceptions focused on the Primary Health Care context. A non-probability sampling technique called snowball sampling was used. Data were collected in June 2019 in the university’s premises using Focal Groups and analyzed through Discourse Textual Analysis. Results: the strengths that the students identified at the time of communicating bad news included teamwork, bonds, self-knowledge, and knowing the patients. Regarding difficulties, the students mentioned a lack of formal preparation, dealing with their own feelings, patients’ responses, and not knowing how to deal with such responses. Regarding the strategies used to communicate bad news, the students mentioned empathy and sensitivity, clear communication, giving hope, scheduling more than one consultation, and finding an appropriate place to talk with patients. Conclusion: the students considered that teamwork, bonds, knowing patients, and self-knowledge are strengths that facilitate the communication of bad news within the Primary Health Care context. Difficulties included lack of preparation and not knowing how to deal with their own feelings. Various strategies were mentioned, such as empathy, sensitivity, and clear communication.

COVID-19 and difficult conversations in critical units: A practical guide for nurses.

The editorial published in this journal in April 2020, entitled “Has COVID-19 forced us to implement better practices?,”1 brought up a relevant and emerging theme. Nurses are the largest group of health care professionals on the front line providing care in the COVID-19 pandemic, working in multidisciplinary teams and participating in the planning of coping strategies in health institutions. Working in a health emergency of such magnitude tends to generate physical and psychological stress that cannot be underestimated.2 Nursing critical care patients of any age group can cause emotional tension and physical exhaustion, and this experience is accentuated when caring for patients infected with COVID-19 at the end of their lives.3 In this context, fear, incapacity, and anxiety regarding breaking bad news can be high because many professionals (especially those who have been relocated to critical units because of the pandemic) are working outside their original units and may possess limited experience to serve families of patients at the end of their lives.2, 4, 5 The term “communicating bad news” or “communicating difficult news” is a communication process that occurs before, during, and after the communication of some bad news and is considered health information that alters a person's perception of the present and future in a negative way.6 Usually, it is the medical team who disclose difficult news to patients and their families. However, nurses who work at the bedside are fully involved in this activity because they spend more time with the patient and often know the details of the needs of both the patients and the families.7 Nurses help families in many instances during the process of communicating bad news; for example, following up conversations to clarify technical terms and jargon, ensuring understanding of difficult information or clarifying the implications of the diagnosis or potential treatments. In addition, families may have a preference for conversations with nurses because of their proximity in the nurse-family-patient relationship and the fragility of the relationship with other professionals from the team.7-9 The task of communicating bad news is a complex skill that requires empathy, appropriate body language, and a welcoming voice tone, among other measures that are impaired in the context of the COVID-19 pandemic.10 Physical distancing prevents touching or hugging, impedes face-to-face conversations regarding the side effects or symptom evolution, and often makes family farewells unfeasible when the patient dies. In turn, the use of personal protective equipment leaves the facial non-verbal language subsumed, weakening both communication and interaction,10, 11 especially in critical care units. We call on all nurses to reflect on the communication of bad news in critical units in the context of the COVID-19 pandemic. In a quick review of the scientific literature on communicating bad news, we observed that there are several protocols in the area of oncology and palliative care, which are widely used in the context of critical care. In the COVID-19 pandemic, such protocols are being rapidly reformulated to a telehealth strategy, which has been useful for several professionals who make up the health team.8, 10-13 However, when it comes to clinical situations that involve nurses in critical units, for example, the communication of death of a patient with COVID-19 diagnostic, mostly young people, there is little evidence about the application of bad news protocols. Our objective was to systematize a practical guide for communicating bad news based on the SPIKES protocol,14 to provide clinical guidance for nurses when caring for family members of patients with COVID-19 in critical care units (Table 1). Communicating difficult news is a highly complex activity and nurses need to feel confident that their participation in the communication process is effective. Although nurses face many challenges participating in this process, this practical guide can facilitate family-centred care centred for patients in critical care units.