Communication: Unwelcome News Flashcards
Skills for breaking bad news?
- Building a supportive and trusting relationship
- Tailor the information to the patients needs (understand the patient perspective)
- Work in a collaborative partnership
What examples of unwelcome news are there?
-suspicious lesions
-lose all their teeth
-require surgery
-very large bill (may be worse for the patient than it would be for you make sure you give accurate empathy)
-cancelling/changing appointments (this may really affect patient whose changed their lives to make the appointment)
It’s subjective! Display appropriate sympathy!
What are the stages to giving bad news?
- Preparation:
- think/identify strategies
- in the middle of a conversation (time to calm them down after and at start warming them up) but make sure they take away the important information (maybe give a leaflet) say ‘I know you’re probably not going to remember this now but here’s some information on it, if you have any questions you can come back and talk to me’ know that you’ll be there ‘let’s make another appointment’
- comfortable/safe setting bring a partner or a friend?
- sufficient time and appropriate knowledge
- put your thoughts/emotions to one side, it’s not about you, you could cry after but not during
- last appointment of day in case it runs over
- non-verbal communication - Discussion:
-summarise situation to date, what are the patients thoughts/feelings?
-negotiate an agenda:
/how much does patient want to know?
-basic, honest info: repeat important points - What next? What are the patients specific concern?
Chunk and check: putting a lot of info into chunks and reducing the things you have to remember - Planning and support
- offer specific help (time when to phone not just phone me)
- develop a plan for what happens next (time frame, ‘we can work on this together’) - Closing:
- summarise and check for understanding
- additional questions?
- set up next appointment
- identify support systems -written materials (worth having some websites for them to look at so they don’t look at inaccurate ones etc) - Review
- what did/didn’t go well
- debrief if possible
How to deal with difficult situations?
- Learn to pre-empt:
-anxiety, discomfort, depression, anger
(Think about what they might be coming in to see you about)
-look at their body language - Justifiable concerns:
- treatment, pain, financial consequences (acknowledge, listen quietly, don’t try to placate)
What problems might you have?
- Patient might not be co-operating (maybe because they didn’t understand what the treatment plan was)
- Negative attitudes to treatment results due to: high expectations. Make sure you discuss beforehand pros, cons, risks, benefits. Failures are more likes to be accepted if they happen with a rational explanation
- Non-payment:
- culture of expectation
- ascertain satisfaction re explanations/treatment/outcomes
- make sure the patient understands what to pay, how much, the way to pay and when to pay
What are the main patient complaints?
Sensitivity Assessment Pain management Poor follow up Lack of consent Discrimination Provider provider communication Insufficient communication Insufficient participation Most complaints aren't because things have gone wrong more on the interaction from the practitioner, not empathetic etc. Not met in a professional manner
How to resolve a complaint
- Confront the confrontation (encourage those involved to express their views)
- Know what the confrontation is about
- Communicate feelings
- Express willingness to co-operate
- Listen to what the others are saying
- Reach an agreement that everyone’s happy with
How to disclose risk
Balance benefits and risks Use evidence based practice Keep up to date Use discussion to augment (answer all questions fully) Act in patients own interest
Why disclose risk?
Let’s patient know they’re at risk (avoids unanticipated outcomes, reduced regret)
Helps determine dominant treatment options (old vs new, side effects)
Motivate patients to reduce risk
Clarify trade off decisions (which risks are most important?)
How best to communicate risk, how much does the particular patient need to know?
What do they want to know?
What’s their motivation, are they asking am I at risk? Is my risk high or low? Different answers for each.
And once you’ve interpreted what they’re asking, decide if you need to give them the absolute risk assessment or say that there’s a small chance this might happen, but it’s not very likely. Or can you just give the ‘gist’ of the risks or do you need to give absolute details. Think about the implications and who you’re talking to.
What’s the meaning of risk concepts?
The possibility of risk depends on the situation and who is involved, so possibility is very important when talking about risk, how likely this thing is going to happen.
Also need to think about relative risk, in relation to a different risk eg. You’re at a higher risk of getting knocked over by a car if you’re not wearing your glasses.
The other way of talking about risk (other than possibility) is by talking about numbers.
What happens if you tell people that the side effect is rare compared to if you say ‘only 4 people in a 1000’ will experience this side effect. (This is the definition of a ‘rare’ side effect anyway)
Less people will come back complaining of that side effect if you have them the numerical value rather than saying it’s ‘rare’.difference in people’s perception of side effects depending on these two ways. Same in reverse for if you say side effect is ‘common’ to if you say ‘it happens between 2 and 10 times in a hundred’.
