Breaking Bad News - Week 5 Flashcards
Definition
Any news that drastically and negatively alters the patients (or their relatives ) view of his or her future
Stereotypical bad news includes
1- terminal diagnoses
- cancer
- motor neurone disease
- multiple sclerosis
Asking difficult questions
DNAR orders
- patient wishes
- advance directives
- informed consent
- relatives
Why is breaking bad news difficult ?
- institutionalised beliefs
- personality types
- gender
- cultural / race
- religion
Some stats
In 1961 , 88% of surgeons questioned routinely withheld cancer diagnosis tending to use euphemisms such as ‘growth’ rather than ‘cancer’
What do patients want to know ?
- patients desire the truth
- they would have liked to see their medical records believing this would improve communication
- 30% visibly anxious about being in a state of not knowing
Breaking bad news can be stressful
Resulting anxiety , burden of responsibility for the news , fear of negative response all lead to reluctance to deliver bad news
Clinicians worry :
- uncertainly about the patients perspective
- fear of destroying Patients hope
- fear of their own inadequacy in the face of uncontrollable disease
- not feeling prepared enough to mange anticipated emotional reactions
- embarrassed at having painted too optimistic a picture for the patient
Distancing strategies
- avoidance
- normalisation
- premature reassurance
- false reassurance
- switching
- jollying along
How to break bad news
- fall in
- listen up
ABCDE pneumonic
A dvance preparation B uild a relationship C ommunicate well D eal with patient reaction E ncourage and validate emotions
Another pneumonic
SPIKES
Setting up Perception Invitation Knowledge Emotions Strategy and summary
How do we do it continued
- where, with whom to whom
- what have you been told
- what do you want to know
- how much do you want to know
- I am sorry /silence
- follow up plan
Empathic communication. Is key
- planning ( not in hospital corridor , names , nurse )
Can you tell me what you know so far
Respond to questions , be honest and use silence
Summarise next step
Body language
Eye contact
Use of pauses
Words are most powerful drug known to mankind
The ineffective negative Vs positive reinforcement or suggestion - how sick do you expect to feel after your chemo
, how well do you expect to feel after your chemo
Don’t think of a pink elephant
Don’t look down
Don’t worry this isn’t going to hurt
How long are you going to be in hospital : how soon are you going home ?
News is bad if …
If it results in ‘cognitive , behavioural or emotional deficit in the person receiving the news that persists after the news is received
Grief response
Numbness for up to 2 week
Distress and acute grief for 6 months
Period of adjustment for 6 to 12 months
- Anger
- Denial
- Fluctuating mood
- Preoccupation with the situation
- Agitated and restless
- Vegetative signs and symptoms
