Breaking bad news

Question 1

why is good communication important for patients (3)

Answer 1

• helps them understand what is wrong and what they should do (improves compliance & outcomes)
• it reduces costs ( avoids unnecessary investigations, hospital admissions)
• patient feels good (reduces fear and distress)

Question 2

why is good communication important to health workers (4)

Answer 2

• job satisfaction
• less medico-legal claims
• reduced workload- either from acute admissions or return visits
• reduces unnecessary expenditures

Question 3

conventional medicine regards truth telling as what

Answer 3

a legal and professional responsibility

Question 4

what do patients understand truth telling as

Answer 4

their right to information about their illness

Question 5

how does culture vs truth telling have to do with ethical dilemmas

Answer 5

• respect for autonomy and right to know
• focus sometimes on how to divulge sensitive information than whether to tell the truth

Question 6

what is bad news

Answer 6

any information which adversely and seriously affects an individuals views of his or her future

** bad news is always however in the eye of the beholder

Question 7

what are the goals of BBN (4)

Answer 7

-gather information from the patient
-provide information to the patient
-support the patient in their emotional response
-involve patient in the planning of treatment

Question 8

what do you want to do during communication with the patient generally (5)

Answer 8

• therapeutic dialogue
• open questions for feelings and reactions
• reiterate and reflect
• silence is golden
• dont interrupt

Question 9

what do you do in the first stage of the modified spikes model(6)

Answer 9

** you prepare yourself for the discussion by asking yourself:
- is this the right place
- if the conversation is sensitive for the patient and family can you make it more private
- have i checked all the relevant information (test results, health passport)
- do i have the correct file for the patient
-have a switched off my phone to avoid distractions
-do i have time

Question 10

in the 2nd stage of the modified spikes models what do you ask (3)

Answer 10

** Gather information from the patient:

• what do they understand about what is wrong with them
• would they like to know more
• would they like someone else to be with them

Question 11

what do you do in stage 3 of the modified spikes model (6)

Answer 11

• in simple language slowly and clearly tell the patient what is wrong with them
• avoid euphemisms
• use warning shot
• dont cover everything
  ** then wait
• observe any response
  -allow time for silence

Question 12

when is suffering is health related

Answer 12

when its associated with illness or any kind of injury

Question 13

when is health related suffering serious

Answer 13

when it cant be relieved without medical intervention and when it compromises physical, social, spiritual and or emotional functioning

Question 14

what do you do in the 4th stage of the modified spikes model (2)

Answer 14

** you ask them if:
- they understand what serious health related suffering means
- there are any other technical words which they need clarification on

Question 15

what do you do in the 5th stage of the modified spikes model (3)

Answer 15

** you ask them:
- if they have any questions
- what are their main concerns

• you offer social and spiritual support

Question 16

what do you do in the 6th stage of the modified spikes model (4)

Answer 16

** you plan with the patient or guardian
- who will see them and when
- how can we address their main concerns
- what treatment will they be receiving and why

Question 17

how can you address the patients emotions/feelings after BBN

Answer 17

have an empathic response:
- watch
- identifying the emotion and if silence, ask an open question
- validate the emotion, connect the emotion with the cause

Question 18

how can you deal with the patients anger (5)

Answer 18

• asses who/what the anger is against
• do not argue
• submissive posture
• have an empathic response, (you sound very angry about…, what are you feeling now…)
  -be safe

Question 19

what do you do during planning and follow up (6)

Answer 19

• you discuss plans for treatment, using their agenda and the medical situation
  -reconfigure goals
  -acknowledge their priorities
  -write down and repeat
• reinforce coping strategies and pleasures
  -the arrangement must be clear and realistic

Question 20

what health worker behavior blocks communication (6)

Answer 20

-quickly offering advice and reassurance
-keep talking then move on
-explain distress as normal
-only attend to the physical aspects
-change the subject
-tell patients to be calm or positive