Communication 2

Question 1

Why is it difficult to give bad news?

Answer 1

Not knowing how best to do it
Fear of upsetting the pt’s existing life
Not knowing the pt, their resources or limitations
Fear of implications for the pt - pain, social and financial loss
Fear of pt’s emotional rxn
Uncertainty as to what will happen next
May fear being blamed

Question 2

How to give bad news?

Answer 2

Preparation
- Consider the info to be given, the setting of the interaction, time considerations

Give information
Check pts understanding of the info
Identify the pt’s main concerns
Elicit the pt’s personal resources and decide on way forward

Question 3

What to consider before seeing the pt?

Answer 3

Is the pt expecting bad news
Should anyone else be present
What does the pt already know
Have I got sufficient time to spend with the pt
Are there any what if q I should prepare for?

Question 4

Calgary-cambridge skills for delivering bad news?

Answer 4

Find out what the pt knows
Find out what they want to know
- Active listening
- Understanding of their perspective
= Empathy
Give information
- Minimum jargon
- Introduce info incrementally
- Pay close attention to pt responses

Question 5

Define empathy

Answer 5

Empathy is the experience of
understanding another person’s condition from their perspective.
You place yourself
in their position.

Question 6

How to deal with emotion?

Answer 6

Empathic response = Identify the emotion, the cause, show connection has been made
“This must be a shock to you”
“I can see you’re upset, I’m sorry to give this bad news”

Question 7

Steps to shared decision making?

Answer 7

1. Shares own thinking as appropriate: ideas, dilemmas
2. Involves patient; offers suggestions and choices rather than
   directives
3. Explores management options
4. Ascertains level of involvement patient wishes in making
   decision(s)
5. Negotiates a mutually acceptable plan; signposts own
   preference on available options, determines patient’s preferences
6. Checks with patient: if accepts plan and concerns have been addressed