Breaking Bad News Flashcards
What can lack of information lead to for patients?
Increase patient uncertainty, anxiety, distress, and dissatisfaction
What is bad news?
Any information that drastically alters a patient’s view of their future for the worse
How does a patient be well informed affect their healthcare?
Maintains trust Prevents unrealistic expectations Reduces uncertainty Allows appropriate adjustment Promotes appropriate communication
Doctors find it easier to treat and care for patients who are well informed
What will patients want to be informed about in bad news?
Diagnosis
Progress of treatment
Progress of disease
How can some cultures view information about terminal illness?
Can view disclosure of terminal illness as harmful, cruel or dangerous
What information must be given to patients that they want or need?
Diagnosis and prognosis
Uncertainties about prognosis/diagnosis including options for further investigation
Treatment options and management, including option of not to treat
Purpose of any proposed investigation or treatment and what it will involve
Potential benefits, risks, burdens and success rates
What is the SPIKES model for breaking bad news?
S - setting and listening skills P - patient's perception I - invitation from patient to give information K - knowledge E - empathy
How can setting and listening skills be good?
Face to face Try not to inform relatives first Privacy No interruptions Allow enough time Find out who the patient wants present Introduce yourself and colleagues (no more than 3 staff) Sit at same level Eye contact Calm No barriers Tissues Listen (silence)
What can be done about P, patient’s perception?
Find out what patient knows already
Start with a general question eg what do you know so far?
What can be done about I, invitation from patient to give info?
Ask how much the patient wants to know
Respect if the patient declines
Allow for denial
Offer opportunity for further discussion
What can be done about K, knowledge?
Warning phrase
Direct patient to diagnosis, info in small chunks
Allow time to consider and ask questions
Check understanding - ask patient to re-cap
Avoid jargon - clear and simple explanations
Incorporate key terms used by patient
What can be done about E, empathy?
Acknowledge king between news and information ie ‘this is news is a shock’
Validate or normalise their emotions
Listen to patient’s concerns
What are some implications of news is broken badly?
Can impact doctor-patient relationship
Affect emotional well being eg distress and depression
Affect adjustment to and ability to cope with the illness for patients and their relatives
Who uses blocking behaviours?
Doctors
What do blocking behaviours involve?
Tells patient distress is normal Changes subject Gives info or advice before concerns have been elicited Focus only on physical aspects Ask leading/closed/multiple questions
