Communication skills - Break Bad News

In the MRCP PACES exam, the commonest case that one would get is Breaking bad news !
I must pay tribute for this section to Dr. Kok Lai Sun, Dr. Yoon CK and Dr. Ong Eng Eng who actually trained me in this till I got a 4/4 in my PACES which then made me pass, if not I used to be something like the cartoon above (Malaysian style).

Example :

Candidate information
You are a medical SHO on call for the coronary care unit(CCU).
Please read the scenario below. You may make notes on the paper provided. When the bell sounds enter the examination room to begin the consultation.

Mrs Tan PS
Age 55 years old
Re : Husband, Mr Tan PS, 60 years old

You are asked to talk to Mrs Tan PS regarding her husband, Mr Tan PS who was a 60 years old man who was admitted to the CCU on the previous evening, after experiencing an acute myocardial infarction. Prior to this he had been fit and well. He was a smoker and had hypertension for the past 10 years. Mr Tan had been thrombolysed and treated appropriately. However, during the night he had developed further chest pains and had a cardiac arrest from which he could not be resuscitated, despite a prolonged resuscitation, and died. Mrs Tan was informed regarding the deterioration through the phone but does not know that Mr Tan has passed away. You are to break the bad news to Mrs Tan.

You have 14 minuted to communicate with the patient followed by 1 minute reflection before discussion with the examiners.

How would you approach this type of scenario ?

• Greet Mrs Tan and introduce yourself
• Enquire if anyone else would like to be around during the conversation (such as other family members)
• Enquire what she knows about Mr Tan and her expectations
• Explain briefly on what prompted the admission and she feels he is progressing
• 'Fire a warning shot' (this is very important) - eg. During the night, Mr Tan had another chest pain and possibly another heart attack. Pause after that
  
• Break the bad news. Go on to explain that Mr Tan's heart stopped beating(after another episode of heart attack). Explain that despite efforts of the medical team, he passed away
• Pause and let the news sink in - let Mrs Tan express the shock and sadness, offer tissue if she cries
• Be EMPATHETIC
• Don't speak to much but be empathetic - such as 'Are you ok to go on' or ' I know this must be hard for you...'
• Answer her questions
• Close the interview