Delivering Bad News (3 questions Mohr) Flashcards
what is a major goal of information delivery
get the patient to cooperate with the recommended treatment
compliance
what is the ABCDE mnemonic
advanced preparation
build a therapeutic relationship
communicate well
deal wit the patient and family reactions
encourage and validate emotions
advanced preparation
familiarize yourself with the relevant clinical information
arrange for adequate time in private setting, turn pager/phone off
consider the environment
-seating, tissues
mentally/verbally rehearse!! what you want to say
prepare emotionally- breathe
build a therapeutic relationship
have a support person present
introduce yourself to everyone
determine how much the patient wants to know
-family may request the physician not tell their loved one
foreshadow the bad news–> i have some difficult news for you today
use touch where appropriate
humor is not ok
assure the patient you will be available; schedule follow ups
what if the family says “don’t tell”
legal obligation to obtain informed consent from the patient
-law states that clinicians must provide as much information as the patient desires
acknowledge the families fears and ask why not?
talk to the patient together
communicate well
ask the patient what they already know or understand
speak frankly but compassionately - say it clearly, gently, then stop
-pause frequently and check for understanding
have pt’s tell you what you have said - encourage questions
pt’s will have difficulty remembering what was said after the initial statement
write things down, use sketches, repeat information that is key
summarize! make follow up plans
what do you avoid during the communication phase
jargon
monologue, promote dialogue
vagueness, confusion
deal with patients and family reactions
assess and respond to emotional reactions
be aware of coping strategies
nonverbal is paramount here!
patient responses could be:
affective
cognitive
physiologic
affective/emotional patient response
quiet tears, sadness hopelessness anger, aggression fear anxiety relief
cognitive patient reponses
denial blame guilt disbelief, shock shame, embarrassed intellectualization
patient response–> physiologic
fight or flight
physically agitated - pacing
deal with patient and family reactions
be prepared for strong reactions
give patients time to react
-state information and wait, watch non-verbals
give permission by naming the feeling *****
“i can see that you are”
Mirro or reflect
-I would be angry as well
“can you tell me what this is like for you?”
listen quietly, attentively
don’t argue or criticize colleagues; avoid defending self or others
encourage and validate emotions
offer realistic hope
discuss options
explore what the news means to the patient
-how will this effect you
determine what support systems they have in place
use other professionals but don’t disengage
attend to your own needs
how is this affecting you as the doc and your personal life
what are some barriers when delivering bad news
denying defeat
- postponing discussions until absolutely sure
- continuing to run tests
- let them know right away
Confusion instead of clarity
-jargon
destroying hope
-delivering bad news doesn’t destroy hope and a will to live
Keeping your distance
-don’t leave the patient feeling abandoned
Disappearing
-the physician believes that since they can’t change the outcome they have no role in the process after delivering bad news- FALSE
