Breaking Bad News Flashcards
What is considered bad news?
Any diagnosis that alters patient’s view of future
Any situation where there is no felling of hope or patient has fewer choices
Subjective depending on patients past experiences and what they consider bad news
What are the principles of bioethics?
Beneficence
Non-maleficence
Autonomy
Justice
How has breaking bas news been handled historically in the healthcare field?
Physicians shelter patients
Avoiding bad news
Non maleficence
Assumed they couldn’t handle the truth
What do patients prefer regarding bad news?
Prefer the truth
Focus on patient autonomy
Why is delivering bad news so difficult?
Emotional, anxiety, burden of responsibility and fear
We are human and we care about our patients
What are the 4 goals of the bad news interview?
Gather info from patient
Provide info based on patient’s needs and desires
Support patient to reduce emotional impact and isolation
Develop a management plan with input from patient
What is Buckman’s 6 step guide to bad news interviews (SPIKES)?
Setting up the interview
Patient’s Perception
Invite patient to share Information
Knowledge transmission to patient
Explore patient’s Emotions and Empathize
Strategy and Summary
What are the mental and physical aspects of setting up the interview?
Mentally review plan for telling patient and how to respond, appear calm and attentive, remember it is sad but still important to plan for the future
Physically find a private location, sit down, turn on lights, remove any instruments limiting full eye contact (slit lamp), invite family/friends into conversation, minimize interruptions.
What is important to gather when considering the patient’s perspective?
Find out how much they already know
Learn how close patient’s impression is to medical reality
How can we invite patients to share information?
Empower patient (ask before you tell)
Find out how much info they prefer
Most prefer full disclosure
How can knowledge be transmitted to the patient.
Give warning shot to lessen shock and facilitate info processing
Use appropriate vocabulary for level of comprehension
Start from where patient is and reinforce what is correct
Avoid info overload
Avoid medical terms
Use analogies and simple language
What are 3 examples of metaphors and analogies that we can use when speaking to patient? (Cornea, optic nerve, artificial tears)
Cornea is a clear covering like a car windshield over the front of the eye
OHN is like a cable to connects eye to brain
AT’s for eyes is like lotion for skin
What is important to avoid during knowledge transmission? Why?
Avoid excessive bluntness
Avoid dissipating hope
Leave patient isolated and angry and blaming you
How can we approach knowledge transmission if the diagnosis is uncertain?
Acknowledging the uncertainty is valuable
Patient has a right to that info
Open exchange of info give great opportunity to plan for future and consider options
How can we respond to a patient’s emotions?
Acknowledge and validate fear
Explore the causes of concern
Recognize patient’s emotions
EMPATHIZE
