Breaking bad news Flashcards
Four important objectives for breaking bad news
Gathering information from the patient: getting an idea of what they know and understand
Transmitting medical information: delivering the news clearly and consisely
Providing support for the patient
Developing a strategy or plan with the patient
What is the SPIKES approach to bad news?
Setting up
Perception
Invitation
Knowledge
Emotions
Strategy and summary
How can you prepare (set up) to break bad news?
Other member of the heathcare team organises appointment
Know history of the patient - condition, treatment options, prognosis
Physical setting - private, furniture, time, no interruptions
People - patient and trusted persons, members of healthcare team
Language and special needs
Why are patient perceptions important in breaking bad news?
Helps to identify what is already known/understood by the patient (listen to words/language used)
Allows you to correct misinformation and tailor the news you have to give to what is already understood
How do you create an invitation to break bad news?
Check what information the patient wants at this time - e.g. are you the sort of person who likes good news or bad news first?
Use a warning shot: I am afraid it is bad news. Would you like me to go on?
If the patient does not wish to know any more, acknowledge and respect his wishes, offering further opportunities for questions at another time
Ask permission to speak to a relative if appropriate
Why is knowledge and information important in breaking bad news?
Enough information is needed to make informed healthcare decisions, but avoid information overload
Information should be given in small chunks, checking understanding and using appropriate language
Respond to reactions and go at the patient’s pace
Emotions and empathic responses used in breaking bad news
Observe for emotion- tearfulness, silence, shock, anger, disbelief
Use silence and open questions
Acknowledge and identify the emotion and respond to it (use open questions to check the emotion)
“I can see that you are upset by this news”
Use silence to allow processing of news and a chance to ventilate feelings (open questions)
How should you close a consultation after breaking bad news?
Strategy and summary:
Summarise areas discussed and check understanding
Formulate a strategy and follow up plan with the patient
Provide written materials: hand written notes, diagrams, leaflets
Copy of the consultation letter
Trusted websites such as Macmillan, MNDA etc
Discuss availability of further support
