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How Do You CDR?

An oncologist I once worked with at a local hospital called it a “shit sandwich”. The communication technique was originally taught to me as “hug-kick-hug”. It's the method used when you want to give bad news but surround it with good words to soften the blow. Unfortunately, both of these terms simplify the method so much as to make it ineffective because it is possible to do it poorly.

Today, I call it “CDR”: an acronym for Context-Disclosure-Reassurance. The general concept is the same. You have something unpleasant to tell somebody, or you wish to bring up a difficult topic for discussion. Whether you are about to inform a patient of a poor medical prognosis, give criticism to an employee, or confront a person about harmful behavior, it can help you to know more about this strategy.

C stands for Context. In this stage, you are (concisely if possible) setting the scene for the relevance of the message and establishing how you hope the listener will integrate what you have to say into what they already know or believe. “Overall you are a dedicated employee,” or “I know you mean the best,” or “You’ve been through a long battery of medical tests,” or whatever. This is an empathetic approach to let your listener know that you are thinking about their point of view.

D stands for Disclosure. This is the point where you state - clearly and unambiguously - the message you need to deliver. A message that might be difficult to hear can often get couched in innuendo or jargon and it is important to avoid these communication traps that can lead to misunderstandings. If the goal is to be understood then language should be straight-forward and direct without being abrasive or aggressive. The words “dying” or “laid off” or “breaking up” can be both hard to hear and hard to say, but without stating them straight-forwardly, the listener is forced to guess what you’re trying to say and they might guess wrong.

R stands for Reassurance. Here is where you follow up the bad news with something positive, and unfortunately this can be a piece that people so often get wrong. Somebody who has just heard bad news does not want empty words, they want something true and meaningful. Reassurance does not exist to soften the blow of the message; it is an offering of support and empathy. So after hearing about a friend’s miscarriage, it’s not reassuring to say, “You can still have more children,” but it can be reassuring to say, “If you ever need to sit and talk or cry, I’m willing to hear you out.”

Now you try. Think about a time when you were given bad news. If you can remember what words were said, try to picture what your emotional reaction was at the time. If you can’t recall the words, then imagine if you were the person having to give this news. What could a person say - using CDR - that would help you hear and understand this message while at the same time acknowledging their own and your own mutual humanity?

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