CCFP priority topic 9 of 105
Bad News on the CCFP exam
4 key features, the mistakes that cost marks, and a practice question.
Checked by a Canadian family physician, MD, CCFP. Updated October 20, 2026.
What the exam tests
Key features
The CFPC’s 4 key features for Bad News. Each one below has how the exam asks it, the common mistakes and the approach.
Practice question
Try one before you read
A real case from the bank, in the new short-menu format. Answer it first. Then read the key features.
Key feature 1 of 4
Where and who tells
Pick a quiet, private place, and keep the news from people who should not hear it.
CFPC skill Patient-centred approach, communicationPhase Treatment
On the exam
A new diagnosis on a busy evening ward, in a two-bed room. Expect one best answer from a short list.
Pick where, when and who tells.
Common mistakes
Telling her behind the curtain because she is in bed: a curtain blocks sight, not sound. Sending the nurse, or waiting a day for a quieter shift, is wrong too.
Approach
- Find a room with a door. A curtain is not privacy.
- Sit down. Hand off your pager or silence it, so nobody interrupts.
- Tell it yourself. The doctor who has the result can answer what comes next.
- Tell it face to face. Not by phone, and not by handing over a lab report.
- For a child's diagnosis, tell both parents together. A parent should not hear it second-hand.
- Keep young children out of earshot. A busy family room is not private.
- Do not sit on a known result while the family keeps asking. Waiting for a calmer day is withholding.
Key feature 2 of 4
How you tell it
Tell the news with warmth and time to spare, and use a trained interpreter when language gets in the way.
CFPC skill CommunicationPhase Treatment
On the exam
Parents who speak little English, a confirmed diagnosis, and a relative offering to interpret. Expect a short menu: you pick several answers from a list.
Pick what to do as you tell them.
Common mistakes
Letting the father, a relative or a bilingual nurse interpret. They soften and filter, and they grieve too. Listing every follow-up test before the news sinks in is wrong too.
Approach
- Start by asking what they know already, and how much they want to hear.
- Give a warning first: “I have some hard news.” Then say it plainly, using the real name of the illness.
- Stop and wait. Let silence and tears happen. Name the feeling you see.
- Give it in small pieces. Save tests and later care for another talk.
- Use a trained medical interpreter, in person, by phone or by video. See the table below.
- No false hope, and no early reassurance. Do not promise recovery, or push a trial the specialist has not offered.
- With a child, use the words she uses. Avoid soft phrases like “gone to sleep”. Talk about time only if she asks.
| Interpreter | Use? | Why |
|---|---|---|
| Trained medical interpreter | Yes | Accurate with medical words. Neutral. Lets you check what she understood. |
| Family member | No | Softens and filters the news. Grieves too. She loses direct access to you. |
| Bilingual staff, no interpreter training | No | Errors in medical terms. Two roles at once. |
| Translation app | No | Unreliable for medical and emotional talk. Cannot check what she understood. |
Key feature 3 of 4
Family: ask first
Get the patient's permission before you tell relatives or bring them into the talk.
CFPC skill Patient-centred approach, professionalismPhase Treatment
On the exam
Your pregnant patient asks about her sister's newborn, also your patient. Expect one best answer from a short list.
Pick what you may say, and to whom.
Common mistakes
Answering the aunt's question about the baby, or inviting her to the family meeting, without the parents' consent. Agreeing to keep the news from one parent is wrong too.
Approach
- Ask the patient who they want told, and who they want in the room.
- For a child, the parents decide who else hears. Each parent has an equal right to know.
- If one parent asks you to keep it from the other, ask what worries him. Then tell them together.
- A relative who is also your patient gets nothing about the other person without consent.
- Answer that relative's own question on its own merits. Her care does not wait on the other family.
- Some families want news to go through one person. Ask the patient; do not assume.
Key feature 4 of 4
Book the next talk
Plan a set time to see them again, to check how the news landed and what they took in.
CFPC skill Patient-centred approach, communicationPhase Follow-upSources Choosing Wisely Canada
On the exam
A rural family, a week after a grave diagnosis. Expect one best answer for the plan, then a short menu for the visit.
Pick when you see them, and what you check.
Common mistakes
“Call if you need anything.” Families in shock rarely call. Handing follow-up to a far-away specialist, or to a referral, leaves nobody checking how they are.
Approach
- Book the next visit before they leave the room. Soon, not in a month. Offer a home visit or a call if travel is hard.
- You gave the news, so you own the first follow-up, even when a specialist leads care.
- Ask what they understood. Have them say it back in their own words.
- Ask how each person is coping: sleep, mood, fear, guilt. A child may think she caused it. Tell her plainly she did not.
- A parent with past depression, crying and not sleeping, needs a depression check and a safety question now. Do not wait for a routine visit.
- Serious illness with distress: bring in palliative care now, alongside treatment of the disease.
- Start advance care planning talks early. Come back to them as things change.
Flashcards
Answer it first, then check.
KF 1The only free room has two beds and a curtain. Is it private enough?
No. A curtain blocks sight, not sound. Find a room with a door.
KF 1The result is back on your evening shift. The parents ask. Do you wait until morning?
No. Tell them now, in a private room, with your pager handed off.
KF 2The father speaks English and offers to interpret for the mother. Do you accept?
No. Use a trained medical interpreter. A family member filters the news and is grieving too.
KF 2You have just named the diagnosis. When do you explain the follow-up tests?
At a later talk. Details given before the news sinks in are not heard.
KF 3The baby's aunt, also your patient, asks about the baby's result. What do you tell her?
Nothing about the baby without the parents' consent. Answer her own question on its own.
KF 3The father asks you not to tell the mother yet. What do you do?
Ask what worries him. Then tell both parents together; she has an equal right to know.
KF 4You ended with “call if you need us.” What is missing?
A booked visit. Families in shock rarely call, so set the next talk before they leave.
KF 4She has a serious illness, is on active treatment, and is distressed. Palliative care now or later?
Now. Palliative care runs alongside treatment of the disease. Do not delay it. Source: Choosing Wisely Canada
FAQ
Does the exam want a named model, like SPIKES?
It marks what you do, not the name. Pick a private place. Ask what they know. Give a warning, then say it plainly. Pause for feelings. End with a plan and a booked visit.
What if no interpreter is free and the family offers to help?
Look for a phone or video interpreter first. A family member filters the news. If you truly have no other way, ask the patient's permission, and book a trained interpreter for the full talk.
Should young children be told?
Yes, in short, plain words that fit their age. Children sense that something is wrong. Silence leaves them to make up their own story, often that it is catching or their fault.
Who tells the news when a specialist made the diagnosis?
Often you, if you have the result and the family is asking now. Do not leave them waiting a week for a far-away clinic. Tell them, then plan the next steps together.
Sources
Written from the CFPC Assessment Objectives and Canadian guidelines first. Checked by a Canadian family physician, MD, CCFP.
Last reviewed October 20, 2026For exam study. Not advice for a patient in front of you.
- Assessment Objectives for Certification in Family Medicine, 2nd editionCollege of Family Physicians of Canada · 2020
- Choosing Wisely recommendationsChoosing Wisely Canada