Giving Bad News Flashcards
1
Q
Define bad news
A
- Any information which adversely and seriously affects an individual’s view of his or her future
- Subjective experience that depends on the patient’s expectations and understanding of the situation
2
Q
How does optimal communication affect the providers?
A
- Report less job stress
- High levels of personal accomplishment
- High levels of confidence
- Less emotional stress and burnout
3
Q
How does optimal communication affect the patients?
A
- Participate more with difficult decision making
- Better outcomes
- Better satisfaction
- Improved understanding of their condition
- Better adherence to treatment plans
4
Q
Who spearheaded the idea of patient centered communication?
A
Dr. Robert Buckman
5
Q
Define patient centered communication
A
- Attention is placed on using verbal and non-verbal behaviors to establish partnership with patients
- Clarifying with patients, in advance, how much information they would like to know
6
Q
What does the SPIKES protocol for giving bad news include?
A
- Set up the interview
- Patient’s Perception
- Invitation
- Knowledge
- Emotions
- Set Goals
7
Q
What does setting up the interview include?
A
- Advanced preparation and choosing appropriate physical location
- Private, quiet, comfortable, and convenient
- Involve all the “key players” to include family or friends whom are the patient’s support system
- Educate yourself about all medical information necessary to answer anticipated questions
- Be mindful of body language and non-verbal clues
8
Q
What does patient’s perception include?
A
- Introduce self and others in the room, and state their role
- State the goal of the meeting – “I asked you here today to discuss Mr. Green’s recent tests results and how this affects the plan for the future.”
- Before you “tell”, “ask” first
- Invite the patient to speak freely about their understanding of what’s been discussed
- “Tell me how you are doing.” “What do you understand about what’s happened so far?”
9
Q
What does invitation include?
A
- Obtain the patient’s invitation to the clinician to talk further about what he or she knows about the patient’s condition
- “Is it okay to speak freely about the information that I have here?” “Is there anything that you wouldn’t want to know?”
10
Q
What does knowledge include?
A
- Actual process of giving information to the patient
- “Warning shot” – “Is there anyone that you’d want to bring with you this appointment? I am afraid we have some serious things to discuss.”
- Use “Ask, tell, ask”
A. Give 3 pieces of information at a time before checking for understanding - Help patient and family find hope – develop a “Hope object”
- “I’m afraid that I have bad news for you.” “The biopsy confirmed cancer.”
11
Q
What does ‘emotions’ include?
A
- Respond humanistically to the patient’s emotions
- Most difficult part of giving bad news
- Wait for patient to react and acknowledge and name the emotion
- Show Empathy:
“I wish I had better news for you.” “I can see that you’re upset. Tell me more about what you’re feeling.”
12
Q
What does setting goals include?
A
- Summarize the conversation and to engage with the patient in creating a clear plan for the future
- Helps to decrease patient’s anxiety
- Work together to come up with decisions
- Write information discussed down so patient can reflect on later and call with questions
13
Q
What are the specific types of hope?
A
- Specific hope
2. Generalized hope
14
Q
Define generalized hope
A
is a sense that there is some future beneficial, but uncertain, development that is not linked to a particular object, and is broad in scope, a sense of “open-endedness.”
15
Q
Define specific hope and its qualifiers
A
- the state of desiring a specific possible event or future state of affairs, called the hope object
A, It must be possible, though it need not be probable
B. The patient’s desire for their specific hope and the perceived likelihood of that specific hope occurring are independent of each other
