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geriatrics 2 > management of selected non pain > Flashcards

management of selected non pain Flashcards

1
Q

Steps in communicating serious news

A
  • Prepare
  • establish the patients understanding
  • determine how much the patient wants to know (ASK)
  • deliver the information (TELL)
  • respond to the patients feeling
  • ascertain the patients understanding (ASK)
  • Organize a plan and follow-up process
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2
Q

How to prepare

A
  • deliver the news in person, privately
  • minimize interruptions
  • Allow time for discussion
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3
Q

What and how much does the patient want to know?

A
  • avoid making assumptions
  • patients have the right to be told the truth and to decline to learn unwanted information
  • REMEMBER
  • -> patient may not want to know full details
  • -> a patient may wish to have a family member informed instead
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4
Q

Delivering serious news

A
  • use phrasing that sends a warning shot to prepare the patients
  • -> i feel bad to have to tell you that the growth turns out to be cancer
  • avoid technical language or euphemisms
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5
Q

After delviering serious news

A
  • Respond to feelings
  • -> use active listening
  • -> encourage expression of emotions
  • -> acknowledge the patients emotions
  • organize a plan and follow-up process
  • -> address the patienst concerns in immediate plan
  • -> set an appointment for a follow-up visit
  • -> sicuss additional tests, referrals sources of support
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6
Q

patient-physician communication

A
  • demanding, challenging
  • classic methods
    • leave patients feeling unheard and unsupported
  • -> leave physicians frustrated demoralized
  • research suggests that most physician aren’t as good at communication as they think
  • effective communication is NOT innate; skills can be learned and can be improved with practice
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7
Q

does better communication really make a differences?

A 
PATIENTS:
- improves patients adjustment to illness
- lessens pain and physical symptoms
- increases adherence to treatment plan
- increases patient satisfaction with care received
PHYSICIANS:
- increases enjoyment in practice
- decreases stress and burnout
- decreases malpractice claims
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8
Q

Premium on communication skills

A
  • depth and breadth of internet usage (make patinets avid consumers of information
  • advances in biomedical technology (make medical decision making more complicated
  • Patients and families need physicians to help INTERPRET the info and ADD medical knowledge, clinical judgment, and experience (WISDOM) that is not available on a website
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9
Q

Talking about serious news

A
  • how the brain processes threats to life
  • -> flight or fight takes precedence over cognitive processes
  • -> autonomic response to threat takes precedence over cognitive processing (out of conscious control)
  • MOST IMPORTANT SKILL TO ACQUIRE IS THE ABILITY TO DETECT AND RESPOND TO THE PATIENTS EMOTIONS
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10
Q

What are key skills about talking about serious news

A
  • RECOGNIZING AND RESPONDING TO EMOTIONS
  • -> Commit to observe and use emotional data in your communication
  • -> notice the patients emotion and NAME it for yourself
  • -> refrain from trying to fix or quiet the patients emotion
  • -> acknowledge the emotion explicitly
  • MOST POWERFUL non-verbal communication is a combination of technical expertise, commitment and integrity - NOT A PRACTICED GESTURE now and then
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11
Q

discussing prognosis

A
  • pitfall = assuming you know what the patient wants

- solution = ask patients how they want to talk about prognosis

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12
Q

patient preference trends

A
  • education correlates with desire for more information

- more advanced illness correlates with wanting less info.

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13
Q

take home message about Prognosis

A
  • before talking about prognosis spend a minute finding out what the patient wants to know
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14
Q

describe the roadmap discussing transition

A
  • prepare yourself
  • ensure the patient or family understands the medical situation
  • assess the patients readiness to talk about whats next
  • use big picture questions to elicit patients values and goals
  • outline worries that are barriers to decision making
  • offer to make a recommendation
  • propose a new treatment plan that meets the patients goals
  • request feedback about your proposal
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15
Q

patients response to transition conversation

A
  • ACCEPT that a transition is occurring = ready for specific end of life planning
  • Want to negotiate = perceive that they are close to a transition but want to see more evidence
  • Decline the clinicians assessment = usually reflects the prospect is too sad, too frightening, or too threatening
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16
Q

take home message about the transition to end of life care

A
  • it is a turning point in a life
  • patients and families may not remember the exact words that you used, but they will remember your respectfulness, attention and empathy
17
Q

Talking about dying

A
  • Pitful = opening the discussion with CPR/DNR and asking separately about every part of resuscitation
  • Solution = guide the patient by developing big picture, talking about he care plan, making recommendation
18
Q

discussing resuscitation preferences roadmap

A
  • decide why you need to discuss a DNA order
  • elicit the patients perception of illness and patients values for care
  • discuss the big picture of whats happening medically
  • make a recommendation about DNR as part of the care plan
  • respond to emotion
  • tell the patient that you will document the conversation and write an order
19
Q

Never ever say….

A
  • There is nothing more i can do for you
    ALTERNATIVE: “there is nothing more i can do to halt your disease, but there is much more i can do for you during the next weeks and months. we will go through this together.”
20
Q

saying goodbye to patients you do NOT expect to see again

A
  • choose an appropriate time and place
  • acknowledge the end of your routine contact
  • invite the patient to respond and use the response as a piece of data about the patients state of mind
  • frame the goodbye as an appreciation
  • give space for the patient to reciprocate
  • articulate an ongoing commitment to the patients care
  • later, reflex on your work with this particular patient
21
Q

take home message about conducting discussion about resuscitation

A
  • conducting discussions about resuscitation preferences is a survival skill for doctors who deal with life-threatening illness
  • saying goodbye is an advanced skill for talking to patients to whom you feel particularly connected
  • these conversations can be tremendously rewarding

geriatrics 2 (13 decks)

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