Management of selected non-pain Flashcards
What are the three steps of giving bad news?
Ask-Tell-Ask
What are the steps in communicating serious news?
- 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
True or false: you should deliver bad news over the phone if possible so that the pt can react in privacy
False
What are the questions to ask to establish the pts understanding?
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?
True or false: pts have the right to be told the truth AND to decline to learn unwanted info
True
Why is it important to use a warning shot in conversation?
To have pt pay attention
What are the two steps to do after delivering serious news?
Response to feelings
Organize a plan and f/u
Is it okay to send pts to others to provide bad news?
If you have to, yes
What are the four things that better communication does for patients?
- improves pts adjustment
- lessens pain/symptoms
- Increases adherence to plan
- Increases pt satisfaction
What are the three things that better communication does for physicians?
- Increases enjoyment
- Decreases stress/burnout
- Decreases malpractice
What is the most important skill to acquire for physicians in talking about serious news?
Ability to detect and respond to pt emotions
Should you refrain from fixing pts emotions?
Yes
What are the steps of verbal acknowledgement?
Name emotion Understand emotion Respect pt Support pt Explore emo
How can you improve non-verbal acknowledgement?
Face squarely Open body Lean toward Use eye contact Relax body posture
What is the most powerful non-verbal communication?
Combination of expertise, commitment and integrity
True or false: Emotional data > cognitive date
true
What is the common pitfall with discussing prognosis? Solution?
Assuming you know what the pt wants
Sol = ask how they want to talk about prognosis
What is the correlation is between wanting to know info and edu level?
Direct
What is the correlation is between wanting to know info and advancing illness?
Advanced = less wanting to know
What are the three general types of people’s response to prognosis?
- Want details
- Big picture
- None
What should you do with pts who don’t want info?
- Figure out why
- Acknowledge concern
- Ask to revisit later
- Make decision if prognosis might change perspective
What should you do with pts that are ambivalent?
- name ambivalence
- Explore pros and cons
- Acknowledge difficulty
- Consider outlining options for discussion
Can a prognosis destroy hope?
It can, doesn’t have to
What is the common pitfall to end of life? Solution?
- Cheerlead until there is absolutely nothing left
- Solution = work on big pictures and goals that are still achievable
When should you offer a recommendation? What should you do, when you do this?
After you have heard the pt–ask for feedback about proposal
What type of questions should you ask pts when transitioning to end of life care?
Big pictures
What are the three responses to the transition to end of life care conversation?
- Accept
- Negotiate
- Decline dr’s assessment
What will pts remember about the conversation toward the end of life?
How you said it, not what you said
What is the pitfall in talking about dying? Solution?
Opening discussion with DNR, and asking about every single part
Solution = Guide pt via big picture, plan, and make a recommendation
What should you close with, with a DNR discussion?
Tell pt that you will document the conversation and write an order
What is the one phrase the Dr. Hirsch will haunt you if you say?
“There is nothing more I can do for you”
How should you frame good-byes?
Appreciation of them, and ensure that you will follow them
