HealthPsych Session 10 Flashcards
When can presumed ‘bad news’ be perceived better than expected?
Relief about having disagnosis Able to be treated Carer feels burden lifted Age Familial obligations
What should be used to tailor info sharing with a pt?
Pt needs, wishes and priorities
Pt knowledge and understanding of condition, prognosis and Tx options
Nature of condition
Complexity of Tx
Nature and level of risk assoc w/investigation or Tx
What MUST you give information that pts want/need on?
Diagnosis and prognosis
Uncertainties and further investigations
Options for Tx and management inc. refusal
Purpose and process of investigation or Tx
Potential benefits, risks and burdens for each option and if these differ among providers
Why is it important to break bad news well?
Maintain trust Decrease uncertainty Prevent unrealistic expectations Allow appropriate adjustment Promote open communication Majority of pts want to know diagnosis, progress and Tx Drs find it easier to Tx informed pts
Why is concealment of information in terminal illness permissible in some cultures?
Disclosure to pt is seen as harmful/cruel/dangerous so family is informed instead
What makes breaking bad news difficult?
Fear of pt's reaction Desire to protect pt Fear of blame Lack of confidence in communication Sense of failure Embarrassment Reminder of own mortality Time constraints
What are the outcomes of poor delivery of bad news?
Poorer dr-pt relationship
Worse emotional well-being
Worse adjustment and ability to cope for pts and relatives
What should be documented when breaking bad news to a pt?
Consultation inc. what the pt was told to avoid repetition/assumptions by future HCP
What model is used for breaking bad news?
SPIKES
What does SPIKES stand for?
Setting and listening skills Patient's perception Invitation from pt to give information Knowledge Empathy Strategy and summary
Describe the Setting and listening skills part of the SPIKES model.
Face to face consultation
Ensure privacy and no interruptions
Ascertain before consultation who pt wants present
Introduce everyone present and keep number to a minimum
Sit down, eyes level, stay calm, no physical barriers, offer tissues
Use silence and repetition as much as possible
What is considered in the Patient’s perception aspect of the SPIKES model?
What do they know already?
Are they prepared/do they know what investigations they have had were for?
Describe the Invitiation from patient aspect of the SPIKES model.
Don’t assume pt wants to know everything
Allow for denial
Offer further discussion/things to take away and read
What happens during the knowledge stage of the SPIKES model?
Warning shot for preparation –> small chunk of info –> timid to consider and ask Qs –> check understanding +/- pt recap –> repeat with another small chunk of info
How should knowledge be communicated when breaking bad news?
Using clear and simple explanations
Avodpiding medical language and euphemisms
Incorporate key terms used by pts
