Management of selected non-pain

Question 1

What are the three steps of giving bad news?

Answer 1

Ask-Tell-Ask

Question 2

What are the steps in communicating serious news?

Answer 2

• Prepare
• Establish their understanding
• Determine how much pt wants to know
• Deliver info
• Respond to pts feelings
• Ascertain pts understanding
• Organize plan and f/u

Question 3

True or false: you should deliver bad news over the phone if possible so that the pt can react in privacy

Answer 3

False

Question 4

What are the questions to ask to establish the pts understanding?

Answer 4

What have other drs told you?
How sick are you?
How is illness impacting your life
What can’t you do that you wish you could?

Question 5

True or false: pts have the right to be told the truth AND to decline to learn unwanted info

Answer 5

True

Question 6

Why is it important to use a warning shot in conversation?

Answer 6

To have pt pay attention

Question 7

What are the two steps to do after delivering serious news?

Answer 7

Response to feelings

Organize a plan and f/u

Question 8

Is it okay to send pts to others to provide bad news?

Answer 8

If you have to, yes

Question 9

What are the four things that better communication does for patients?

Answer 9

• improves pts adjustment
• lessens pain/symptoms
• Increases adherence to plan
• Increases pt satisfaction

Question 10

What are the three things that better communication does for physicians?

Answer 10

1. Increases enjoyment
2. Decreases stress/burnout
3. Decreases malpractice

Question 11

What is the most important skill to acquire for physicians in talking about serious news?

Answer 11

Ability to detect and respond to pt emotions

Question 12

Should you refrain from fixing pts emotions?

Answer 12

Yes

Question 13

What are the steps of verbal acknowledgement?

Answer 13

Name emotion
Understand emotion
Respect pt
Support pt
Explore emo

Question 14

How can you improve non-verbal acknowledgement?

Answer 14

Face squarely
Open body
Lean toward
Use eye contact
Relax body posture

Question 15

What is the most powerful non-verbal communication?

Answer 15

Combination of expertise, commitment and integrity

Question 16

True or false: Emotional data > cognitive date

Answer 16

true

Question 17

What is the common pitfall with discussing prognosis? Solution?

Answer 17

Assuming you know what the pt wants

Sol = ask how they want to talk about prognosis

Question 18

What is the correlation is between wanting to know info and edu level?

Answer 18

Direct

Question 19

What is the correlation is between wanting to know info and advancing illness?

Answer 19

Advanced = less wanting to know

Question 20

What are the three general types of people’s response to prognosis?

Answer 20

1. Want details
2. Big picture
3. None

Question 21

What should you do with pts who don’t want info?

Answer 21

1. Figure out why
2. Acknowledge concern
3. Ask to revisit later
4. Make decision if prognosis might change perspective

Question 22

What should you do with pts that are ambivalent?

Answer 22

• name ambivalence
• Explore pros and cons
• Acknowledge difficulty
• Consider outlining options for discussion

Question 23

Can a prognosis destroy hope?

Answer 23

It can, doesn’t have to

Question 24

What is the common pitfall to end of life? Solution?

Answer 24

• Cheerlead until there is absolutely nothing left

- Solution = work on big pictures and goals that are still achievable

Question 25

When should you offer a recommendation? What should you do, when you do this?

Answer 25

After you have heard the pt–ask for feedback about proposal

Question 26

What type of questions should you ask pts when transitioning to end of life care?

Answer 26

Big pictures

Question 27

What are the three responses to the transition to end of life care conversation?

Answer 27

• Accept
• Negotiate
• Decline dr’s assessment

Question 28

What will pts remember about the conversation toward the end of life?

Answer 28

How you said it, not what you said

Question 29

What is the pitfall in talking about dying? Solution?

Answer 29

Opening discussion with DNR, and asking about every single part

Solution = Guide pt via big picture, plan, and make a recommendation

Question 30

What should you close with, with a DNR discussion?

Answer 30

Tell pt that you will document the conversation and write an order

Question 31

What is the one phrase the Dr. Hirsch will haunt you if you say?

Answer 31

“There is nothing more I can do for you”

Question 32

How should you frame good-byes?

Answer 32

Appreciation of them, and ensure that you will follow them