title: A new model for breaking bad news to people with intellectual disabilities.
abstract: OBJECTIVE
  To develop a model for breaking bad news that meets the needs of people with intellectual disabilities (IDs).
  
  
  METHODS
  A two-phase qualitative study featuring: (I) focus group meetings, on-line focus groups and one-to-one interviews; (II) structured feedback from participants and other stakeholders.
  
  
  METHODS
  Participants were drawn from National Health Service hospitals, Primary Care Trusts, independent organisations and on-line forums across England.
  
  
  METHODS
  109 participants were purposively selected: 21 people with mild/moderate IDs, 28 family carers, 26 ID professionals and 34 general health professionals.
  
  
  METHODS
  Feedback on a preliminary model for breaking bad news to people with IDs was collected from 60 participants and other stakeholders to assess relevance and acceptability, before the model was finalised.
  
  
  RESULTS
  Breaking bad news is best seen as a process, not an event or a linear series of events. Bad news situations usually constitute a wide range of discrete items or chunks of information. 'Building a foundation of knowledge' is central to the model. Information needs to be broken down into singular chunks of knowledge that can be added over time to people's existing framework of knowledge. Three other aspects should be considered at all times: capacity, people and support.
  
  
  CONCLUSIONS
  Patients who have IDs do not easily process verbal information in a clinical setting. The new model for breaking bad news to people with IDs needs to be tested in practice using robust outcome measures. The model's relevance to wider patient groups should also be evaluated.
authors.affiliation: Division of Population Health Sciences and Education, St George's University of London, London, UK. ituffrey@sgul.ac.uk
authors.forename: Irene
authors.initials: I
authors.lastname: Tuffrey-Wijne
mesh_terms: D003144:Communication Barriers; D004739:England; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008607:Intellectual Disability; D008962:Models, Theoretical; D010166:Palliative Care / Q000379:methods*; D017410:Practice Guidelines as Topic; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D014342:Truth Disclosure