Session 10 Flashcards
Define ‘Bad news’
Any information that drastically alters a patient’s view of their future for the worse
What are some examples of Breaking Bad news situations?
Terminal prognosis Disabling condition Traumatic/sudden death Infertility Antenatal testing Intra-uterine death
Why is it important to tell patients when there is bad news?
Maintain trust Reduce uncertainty Prevent unrealistic expectations Allow appropriate adjustment Promote open communication
How can you break Bad news to patients?
Full disclosure delivered with empathy, kindness and clarity
SPIKES
10 Step approach
What is SPIKES?
Setting and listening skills Patient's Perception Invitation from patient Knowledge Empathy Strategy and summary
How do you achieve Setting and listening skills?
Face to face communication Allow time No interruptions Find out who the patient wants present Introduce self and colleagues (No more than 3) Sit down, same level and calm. No physical barriers Listening mode = Silence and repetition
How do you achieve the Patient’s Perception?
Before explaining, find out what the patient already knows
How do you achieve Invitation from patient to give information?
Don’t assume the patient wants to know everything
Ask them
If patient refuses information, allow denial and offer opportunity for further discussion
How do you achieve Knowledge when braking bad news?
Give a warning sentence eg sorry I have to tell you
Give information in small chunks leading towards diagnosis, check understanding
Avoid jargon
How do you achieve Empathy when breaking bad news?
Respond empathetically eg how are you feeling?
Listen to patient’s concerns
How do you achieve Strategy and summary?
Summarise main points and check understanding
Agree on next step
Discuss strategy, optimistic but not inappropriate reassurance
Signal closure, give opportunity to ask questions
Offer written information
If patient is distressed ask if they want someone with them
