Delivering Bad News Flashcards
What is bad news?
situations where there is either a feeling of no hope, threat to a person’s mental or physical well-being, a risk of upsetting an established lifestyle, or where a message is given which conveys to an individual fewer choices in his or her life
Why is bad news delivery important
- It is a frequent occurence
- 74% of providers deliver BN - Legal and Ethical oblications (informed consent)
What are the effects on clinical outcomes?
- Patient Satisfaction
- Treatment Compliance
- Psychiatric State
- Lifespan
- Quality of Life
Is there a lack of provider training when giving bad news?
Less than 25% of physician have had training in bad news delivery
What are the important factors defined by patients?
- Personalization
- Quality
- simplicity
- Accessibility
- Multiplicative effect
What are the patients desires?
For the physician to: exhibit empathy, be honest and encourage questions
For the environmental factors to be: sitting face-to-face, promote privacy, set aside time, encourage inviting loved ones, remove distractions
What are the factors that influence patient response to bad news?
Expectations Previous experiences General personality disposition Demographics Types of responses: shock, horror, anger, disbelief, denial, acceptance
How are patients different?
Females
Patients with higher education
Elderly
How are different doctors characteristics?
- Inexperienced Messenger
- Emotionally burdened
- Rough and Ready
- Benevolent but tactless
- Distanced doctor
- Empathetic !!!!! BEST!
What is involved in the provider’s perspective?
Emotional challenges
Competing Impulses
Inferring patient preferences
Lack of training
What are the emotional challenges?
Fear of:
being blamed for poor outcomes, patient reactions, and inadequate
Feelings of:
anxiety, guilt, sadness
What are the three major tensions?
Autonomy vs. Connection
Openness vs. Closedness
Novelty vs. Predictability
What is inferring patient preferences?
Rating and detecting patient distress
Determination of patient viewpoint
Recognizing need for emotional support
What occurs with lack of training?
BN delvier often comes early in career
Inadequate guidance and help
Resort to trial and error
Negative experience for physician and patient
What are the types of BN delivery?
Non-disclosure
Full disclosure
Individualized disclosure
What is non-disclosure?
Assumptions:
Physician decides for patient, patient doesn’t want to know BN, patient need to be protected from BN
What are the key characteristics in non-disclosure?
Ambivalence, use of euphemisms, ambiguity
What is involved in full disclosure?
Appropriate for patient to make own decisions
Patient has the right to full information
No account for patient’s desire
Key Characteristics
– general bluntness
– lack of concern for patient
What is involved in individualized disclosure?
Assumptions: Different coping mechanisms Different desires Key characteristics: - Tailoring amount and rate of disclosure - simple strategy --> ask the patient - most effective - better clinical judgement
What is SPIKES?
A delivery protocol: S - setting P - Perception I - Invitation K - Knowledge E - emotions/ empathy S - sympathy / summary
What is the setting
Setting up the interview
- arrange for a convenient time
- manage time restraints
- arrange for privacy
- Involve family /sign others
What is perceptions?
Assessment of patients perception:
Ask patient what they know (open end)
Correct misinformatin
Tailor bn to patients understanding of condition
What is obtaining patient’s invitation
Ask patient if they want to know results
Respect the patient’s decision
What is giving knowledge?
Speak at a level of patient comprehsion
give info inchunks
Periodically check for understanding
Provide alternative resources for learning
