B4 W4: Breaking bad news

Question 1

What is the definition of bad news in healthcare?

Answer 1

• bad news pertains to situations where there is:
  
  • a feeling of no hope
  • threat to a persons mental or physical well being
  • a risk of upsetting established lifestyle
  • where message given conveys to individidual fewer choicer in his/ her life
• its effect results in:
  
  • cognitive/ behavioural/ emotional defecit in receiver of news
  • that persists for some time after news has been received.

Simple definition: Any info which adversely and seriosuly affects an individuals view of his/ her future

Question 2

Identify contexts of bad news for different HCP’s

Give examples of HCP’s and types of bad news

Answer 2

• oncologist and cancer diagnosis
• hospital specialists and diagnosis of life long illness
• antenatal ultrasonogrophers and foetal abnormality on antenatal screening
• irreversible visual loss
• diagnosis of infertility
• neurodevelopmental prognosis in extreme preterm
• Occupational therapists/ SALT / Physiotherapists -> reaching maximal therapeutic effect, full recovery not possible etc..

Question 3

Why is breaking bad news difficult?

Question 4

What is the approach to use when breaking bad news?

Answer 4

SPIKES approach

Setting up

Perception

Invitation

Knowledge

Emotions

Strategy and summary

Question 5

SPIKE

What is involved in the setting up stage?

Answer 5

• Prepare yourself to give the bad news:
  
  • avoid interruptions
  • make time available
  • put aside own emotional baggage
• Who is the news shared with?
  
  • significant others , encourage if patients want
• What?
  
  • read patient record
  • know test results and the implications
  • know the next stage of treatment
  • prognosis
• where?
  
  • private place
  • seating arranged
• when?
  
  • plan in advance if possible

Question 6

SPIKE

what is involved in patient perceptions?

Answer 6

• you need to establish what is already known/ understood by the patient
• clarify their understanding with open qu (e.g what have you been told about you condition/ results/ operation?)
• summarise the current position -> correct any misinformation, establish shared common understanding
• identify any recent developments –> “how have you felt since then?”
• be aware of who answers the qus either patient or relative

Question 7

SPIKE

Invitation to break bad news

Answer 7

• Offer “warning shot” –> “ i’m afraid the news is not as good as we’d hoped.”
• explore how much information is wanted –> “would you like me to go on/ know more?”
• If they dont want to know –> offer to answer any qus they may have in the future or talk to relative

Question 8

SPIKE

Knowledge and information

Answer 8

• keep explanation clear and simple
• give info in digestible chunks -> allow patient to consider response before going on, give positive aspects first
• avoid medical language
• use silence/ dont be afraid of silence
• check their understanding periodically
• repeat the important facts
• arrange second session if needed

Question 9

SPIKE

Emotion

Answer 9

• observe emotion and give time to process
• identify and acknowledge emotion –> “I can see this is a huge shock for you. “
• respond empathetically –> “I wish it were better news, I’m so sorry.”
• encourage expression of feelings and watch for “shut down”.
• do not be afraid of silence, give time and space.

Question 10

SPIKES

Strategy and summary

Answer 10

• Make a plan together e.g. when to meet again, seeing specialists, reassure patient they are going to/ have been referred to app. team of specialists.
• Summarise -> repeat important points, check understanding
• invite qu’s
• offer ongoing assistance to the patient should they think of further qu’s e.g. give details or clinical nurse specialists, support groups, websites
• offer written materials if relevant and available.

Question 11

What should you do when the consultation is over?

Answer 11

• Record the conversation in medical notes -> used specific words used
• inform nursing/ other HCP’s involved in patient’s care
• letters should explain what patient has been told
• time out for yourself -> be aware can be challenging for you especially if buily up rapport w patient, reflect on feelings and take time out if needed.

Question 12

Follow up for patient after bad news

Answer 12

• Do not rush patient to make decisions unless unavoidable
• set up early follow up : face- face, phone
• involve other HCP’s
• identify their support systems
• often to see/ tell family or to do it together

Question 13

patient confidentiality vs concerned relative?

Answer 13

• 1st duty of care is to your patient
• avoid informing relatives first
• listen to relatives concerns but do not agree to collude
• do not assume the patient wants family member present
• if patient does not want information ask permission to discuss with relative