Breaking Bad News

Question 1

Bad news

Answer 1

Any info which adversely or seriously affects an individuals view of his or her future (may be different for some compared to others and may reflect cultural or religious beliefs)

Question 2

What are pitfalls in physicians giving bad news (4)

Answer 2

Being too blunt
Patient getting the sense there is no hope
Inappropriate place or time
Too much jargon

Question 3

What are the four goals in giving bad news?

Answer 3

1. To determine patient knowledge
2. To provide info to patient
3. To support the patient
4. To develop a strategy so patient leaves consultation knowing what to do next

Question 4

What is SPIKES?

Answer 4

S = Setting
P = perception
I = invitation
K = knowledge
E = emotions
S = strategy/setting

Question 5

What is “S” (setting)

Answer 5

Setting up the interview
Arrange for some privacy, sit down with patient + possibly involved significant others
Make connection with patients
Manage time constraints

Question 6

What is “P” (perception)

Answer 6

Assess the patients perception
Ask before you tell - find out what their understanding is + what they expect from the consultation
Helps establish their level of hope

Question 7

What is “I” (invitation)

Answer 7

Obtain the patient invitation
Check if th patient wants to know now or would like a family member present “how would you like me to give you info about your test results?”

Question 8

What is “K” (knowledge)

Answer 8

Give the patient the knowledge = tell diagnosis
Chunk diagnosis then pause/wait - allow them to take it in
Don’t launch into explaining everything
Allow the patient to direct the consult from here

Question 9

What is the “E” (emotions)

Answer 9

Address the patients emotions with an empathetic response.
Identify the emotion + the reason for it
Use exploratory questions
Let the patient know you have connected with their emotion + encourage expression of feelings

Question 10

What is the “S” (strategy)

Answer 10

Identify a strategy and plan for what will happen next (broad time frame) and emphasise quality of life

Question 11

How do you close up the session

Answer 11

1. Confirm 3 key points
2. Confirm Dr + pt plan + when they will return
3. Signpost endo of consult = closing comment, thanks/reassurance, gesture (leaflet/prescription) and direct to source of info