Ch 10 Flashcards
What is the title of the chapter?
Chapter 10 - Breaking Bad News.
What is bad news?
Any news that drastically and negatively alters the patient’s view of their future. It is a message that has the potential to shatter hopes and lead to very different lifestyles.
What are some examples of bad news?
Cancer diagnosis. Intrauterine fetal death. Lifelong illnesses (e.g., diabetes, epilepsy). Poor prognosis related to chronic diseases (e.g., heart failure). Informing parents about their child’s serious mental/physical handicap. Non-clinical situations (e.g., giving feedback to poorly performing trainees or colleagues).
What do patients and their families expect when receiving bad news?
Privacy. Empathy. Dignity. Clarity of message. Competency. Time for questions.
What rights do patients have when receiving bad news?
Accurate and true information. The right to receive or not receive bad news. Decide how much information they want. Decide who should be present during the consultation (e.g., family members). Decide who should be informed about their diagnosis and what information that person(s) should receive.
What are some common responses to bad news?
Denial. Agitation. Shock. Helplessness. Anger. Sense of unreality. Guilt. Misinterpreting information. Blame. Regret/anxiety.
What should you do when breaking bad news?
Ensure privacy and confidentiality. Be sensitive to non-verbal language. Respect the patient. Allow for silence, tears, and other reactions. Be honest. Use simple language. Listen actively. Document and liaise with the multidisciplinary team.
What should you do not do when breaking bad news?
Overload with information. Withhold information. Distort the truth. Give false reassurance. Assume you know what is concerning the patient. Feel obliged to keep talking all the time. Criticize or make judgments.
What are some specific things to avoid when breaking bad news?
- Meeting in public. 2. Being alone. 3. Hurrying. 4. Not being prepared. 5. Being interrupted by your mobile phone. 6. Patronizing (e.g., ‘It is all your fault you smoked’). 7. Giving specific prognoses (e.g., ‘You have 6 months to live’).
What is the first step in the SPIKES protocol for breaking bad news?
S: Setting. Arrange for privacy. Sit down. Make a connection and establish rapport with the patient. Manage time constraints and interruptions.
What is the second step in the SPIKES protocol?
P: Perception. Determine what the patient already knows. Listen to the patient. Accept denial but do not confront at this stage.
What is the third step in the SPIKES protocol?
I: Invitation. Ask the patient if they wish to know the information. Accept the patient’s right not to know. Offer to answer questions later if they wish.
What is the fourth step in the SPIKES protocol?
K: Knowledge. Use language appropriate to the patient. Give information in small chunks. Give the diagnosis (e.g., cancer). Mention any positive aspects (e.g., cancer has not spread). Check whether the patient understood what you said.
What is the fifth step in the SPIKES protocol?
E: Explore. Prepare to give an empathetic response. Give the patient time to express their feelings, then respond.
What is the final step in the SPIKES protocol?
S: Strategy (Summary). Ask if the patient wants to clarify anything else. Offer an agenda for the next meeting (e.g., ‘I will speak to you again when we have the opinion of the cancer specialist’). Close the interview.
What is the importance of breaking bad news effectively?
It is a difficult but fundamentally important task for all healthcare professionals. Focused training in communication skills and techniques improves performance. It enhances patient satisfaction and physician comfort. It is an essential skill of good medical practice.
