Difficult communication skills

Question 1

What to answer to the patient question: ‘Am I going to die?’

Answer 1

Initial response: What makes you say that?

Then: Have you been given prognosis?

Prepare for the worst (so patient can plan but hope for the best)

‘In the worst-case scenario…’

Question 2

How do break bad news? (model)

Answer 2

SPIKES

S - setting

P - perception → what the patient has already know

I - invitation → how much details would you like to know? Do you prefer to just know the main ‘headings’?

Warning!

K - knowledge → bad news

E - empathy → ‘I can see that it made you very upset/distressed/angry’

S - summary → plans

Question 3

What to do/say if a patient burst into tears/ is angry?

Answer 3

• give them space (let them cry/ be angry)
• acknowledge: ‘Am I right in thinking that you are upset? Distressed? Angry?’

Question 4

How to approach DNACPR talk?

Answer 4

We do it so we don’t treat people against their wishes

• establish that there is a diagnosis
• Explain that chances of success of CPR are low
• Chances of harm are high → potential to bring a patient back into worse situation: broken ribs, ruptures spleen/liver, treated in ITU, brian damage, undignified death, artificial ventilation, renal dialysis