Exam #2: Communication: Patients with Serious Illness Flashcards
What are the steps to communicating serious news?
1) Prepare
2) Establish patient’s understanding
3) Determine how much the patient wants to know
4) Deliver the information
5) Respond to patient’s feelings
6) Ascertain patient’s understanding
7) Organize and plan follow-up
What do you need to remember to do when you’re delivering bad news?
Need to deliver a “warning shot” e.g. “This is going to be a significant conversation…”
How does the brain process threats to life?
“Flight or fight”
- Need to lets these moments pass so they can eventually take in cognitive information
What is the most important skill for physicians that deliver bad news?
Must be able to detect and respond to the patient’s emotions
What is the mnemonic used to acknowledge the patient’s emotions verbally?
NURSE
What is the mnemonic used to acknowledge the patient’s emotions non-verbally?
SOLER
What do you need to keep in mind about prognosis?
Ask the patient how they want to talk about prognosis
What do higher levels of education correlate with?
Desire for more information
What do higher levels of illness correlate with?
Wanting less information
When asking people how to talk about prognosis, what are the three “options” that you can offer?
- Details
- Big picture
- Not discuss
Can a poor prognosis destroy hope?
Depends–need to tell the truth thoughtfully not bludgeon with it
How do you transition from acute care to palliative care?
1) Prepare
2) Ensure the family understands the situation
3) Assess readiness to talk
4) Use big picture words to elicit values and goals
5) Outline worries
6) Make a recommendation
7) Request feedback
What should you never say to a patient?
“There is nothing more I can do for you.”
