Communication CBM Flashcards
1
Q
What are the principles of patient-physician communication in palliative care?
A
- reduces distress
- improves adherence to care
- Improves satisfaction
- communication with physician is one of the most important factors at end of life.
2
Q
List barriers to effective communication
A
- Discomfort asking questions
- Pre-existing misinformation
- lack of trust in health care system
- language barrier
- cultural barriers
- Physician fears about diagnosis
- Physician difficulty dealing with emotions
3
Q
FIFE
A
- Feelings
- Ideas
- Function
- Expectations
4
Q
Breaking Bad News
A
- Since 1970s, 97% patients indicated would want to know if they had cancer.
- Disclosure of diagnosis and prognosis is norm in western countries / Anglo-Saxon origin
- Most patients wish for full information, shared decision making
- Highly educated, younger and female patients most likely
- Other cultures variable
- Physician underestimate patients’ desire for information
- Make NO ASSUMPTIONS, individuals vary.
- ASK how much information they would like
5
Q
SPIKES
A
- SETTING
- environment, review chart, privacy, dedicated time, all family members, introductions, sit down
- PERCEPTION
- What does patient understand about their situation?
- KNOWLEDGE
- let the patient know bad news before further details
- non technical language
- slow pace, check for understanding
- clear words, not excessively blunt
- discuss news and plans for future
- EMOTIONS
- Silence, empathy
- STRATEGY/SUMMARY
- not too long of a meeting
- make a plan for future (treatment, test, follow up)
- summarize the information
6
Q
How would you respond to requests from family or friends for information about a patient?
A
- first responsibility to patient
- confidentiality
- cannot disclose without explicit consent
- Explore why
- don’t want to cause stress/be a burden
- financial concerns
- fears about stigmatizing
7
Q
Prognosis sharing
A
- inaccurate information sharing
- misunderstood
- unable to process information
- understand why prognosis is important (attending specific event for example)
- “Not curable”
- range of time (short days, weeks, short months, etc)
- important to convey you will not abandon them
8
Q
Prognosis and hope
A
- importance of not removing all hope during communication of bad news
- hope: “expectations of something that is realistically possible”
- some patients prefer ambiguity about the future
- Can respect patient’s desire to not have details about prognosis
- Hope may evolve as disease progresses (cure to more time to quality of life to peaceful death)
- I wish, I worry, I wonder
9
Q
When would you need to hold a family meeting?
A
- ensure all family members are on the same page
- change in status in patient
- change in treatment plan
- discord among family
- plan for discharge
10
Q
Family conference
A
- therapeutic intervention in pall care
- indications : change in status, change in treatment plan, discord among family members, discharge planning
- Pre-meeting with team
- private setting, circle, let hospital roommates know, all family members and professionals required
- Format:
- Introductions
- Goals/agenda
- Ask for input
- Clarify family/patient current understanding
- Summarizes current situation/medical information from the point of view of treating team
- Move towards a treatment plan/goals for care
- Summarize
- Designate a family spokesperson
11
Q
Denial
A
NURSE ACRONYM
- NAME the emotion
- UNDERSTAND : normalize the emotion
- RESPECT : state your appreciation of efforts
- SUPPORT: focus on patient and needs and offer help
- EXPLORE: open up discussion to the emotion or distress
Denial can be an inaccurate label for a patient or family member without adequately addressing person’s point of view and suffering.
12
Q
Substitute Decision Making
A
- Canada : partner/spouse > adult children > parents > siblings
- families with higher levels of pre-existing conflict likely to have stronger preferences for life prolonging care.
- Advanced care planning reduces conflict and stress
- SPIKES approach with family members
- What do they feel family member would want?
- Explore what the patient has expressed about their QOL
- Outline severity of condition, recent history
- Discuss risks vs benefits of each proposed course and impacts
- Burden without benefit
- Provide guidance
- If no consensus :
- postpone decision making
- time limited trial of therapy
- Third party (ethics, ICU, etc)
13
Q
List barriers to discussion of imminent death with family
A
- unrealistic hope
- lack of definitive diagnosis or event causing death
- poor communication skills
- concerns about what interventions, medications, treatments might be requested.
- fear of shortening life
- cultural, spiritual barriers
NOT DISCUSSING IMMINENT DEATH:
- loss of trust
- dissatisfaction with quality of death
- uncontrolled symptoms
- family members not being present
- unmet cultural and spiritual needs
- inappropriate interventions
14
Q
After Death
A
- Time for spiritual/religious rites
- Practical matters (death certification, morgue, funeral home)
- primary health care provider make contact with family
- grief and bereavement support
15
Q
Avoiding Physician burnout
A
- emotional exhaustion
- depersonalization
- cynicism
Strategies:
- transcendental perspective
- hobbies
- clinical variety
- setting boundaries
- personal relationships
- team debriefing
