Derm - breaking bad news Flashcards
Define what breslow thickness is and whats it used for
Breslow’s depth, used as a prognostic factor in melanoma of the skin. It is a description of how deeply tumor cells have invaded. Measures form the Granular layer down to the deepest cancerous cell
What is the Buckman 6 step protocol used for ?
Breaking bad news
What is involved in step 1 of Buckman 6 step protocol ?
Getting Started
- Getting the physical context right
- Where?
- Who should be there?
- Starting off
What is involved in step 2 of Buckman 6 step protocol ?
Finding out how much the patient knows
What is involved in step 3 of Buckman 6 step protocol ?
Finding out how much the patient wants to know
What is involved in step 4 of Buckman 6 step protocol ?
Sharing the information
• Decide on your agenda (diagnosis/treatment
plan/prognosis/support)
• Start from the patient’s starting point
• Give information in small chunks
• The warning shot - if appropriate
• Use simple English, not jargon
• Check frequently that the patient has understood and
clarify any points
• Listen for your patient’s agenda, concerns and anxieties
• Try to blend your agenda with the patient’s
What is involved in step 5 of Buckman 6 step protocol ?
Responding to patient’s feelings
• Identify and acknowledge the patient’s reaction
What is involved in step 6 of Buckman 6 step protocol ?
Planning and follow through
- Organising and planning
- Making a contract and following through
What should you do before giving the patient their results and if need be following the Buckman 6 step protocol ?
Take a quick focused history to establish a rapport, learn about home circumstances e.g. if support needs to be put in place. Establish baseline for patients knowledge about the condition. Relevant clinical info.
What are the main areas in a focused history ?
- Short history of presenting complaint
- ▪ Relevant Past medical history
- ▪ Relevant Drug history / allergies
- ▪ Relevant Social / Family history
- ICE
- Including what have they been told already
