Temrinal Illness And Breaking Bad News Flashcards
What are the ‘three main patterns of dying’?
Gradual death
Catastrophic death
Premature death
Define ‘gradual death’
Death with a slow decline in ability and health
Define ‘catastrophic death’
Death through sudden and unexpected events
Define ‘premature death’
Death in children and young adults through accidents or illness
Outline the 5 stages of grief
Denial
Anger
Bargaining
Depression
Acceptance
Define ‘denial’ as a stage of grief
Where the person uses denial to adjust to the fact they are dying without being emotionally overwhelmed.
Define ‘anger’ as a stage of grief
Anger stems from a frustration at dying and is often directed at those closest to the person. Will often ask questions such as ‘why me?’.
Define ‘bargaining’ as a stage of grief
People often try to make a deal with God or medical professionals so they can live, promising good behaviour in return for their life.
Define ‘depression’ as a stage of grief
Often occurs when the person realises that there is nothing that can be done. Often seen as ‘anticipatory grief’ where the person mourns their own death.
Define ‘acceptance’ as a stage of grief
Where the person accepts their death with calmness and peace.
What does denial allow for in the early stages of receiving bad news?
Allows a way to cope with overwhelming information and emotions.
What is it important to do when a patient is exhibiting denial?
Check that they understand, and how much information they want to know.
Respect their desire ‘not to know’
How can help be given to patients in the denial stage of grief?
Offer written information for them to look over with their family
Check and review them over time - when they are ready
Why is it important to deliver bad news appropriately?
It can have an impact on:
- doctor-patient relationship
- emotional well-being of the patient
- adjustment to and ability to cope with the illness, for patients and their relatives
Is ‘bad news’ always bad news?
No
Why can bad news sometimes be seen in better light?
Some (but certainly not all) patients may be relieved to have a diagnosis, may feel they can now have at least a chance at treatment or to be relieved of pain, and they may feel like a burden has been lifted from the carer
On what factors should you tailor your approach to the breaking of bad news?
- Their needs, wishes and priorities
- Their level of knowledge about their condition
- The nature of their condition
- The complexity of the treatment
- The nature and level of risk associated with the treatment
What model is recommended to break bad news?
SPIKES
What does SPIKES stand for?
Setting - and listening skills Patient's perception Invitation from patient Knowledge Empathy Strategy and summary
Outline the first ‘S’ in the SPIKES model
- Break news face-to-face
- Ensure privacy, no interruptions and adequate time
- Find out who the patient wants present
- Introduce yourself and colleagues
Outline the ‘P’ in the SPIKES model
Find out the patient’s perception of their condition, ‘ask before you tell’
Outline the ‘I’ in the SPIKES model
Wait for or look for an invitation from the patient to provide them with information
Outline the ‘K’ in the SPIKES model
-Give a warning shot:
“I’m very sorry to have to tell you this”
-Direct them to the diagnosis in small chunks
Avoid jargon, and align language used with the patients
Outline the ‘E’ in the SPIKES model
Provide an empathetic response to the patient. Ask how they feel about the information and listen to their concerns.
Outline the second ‘S’ in the SPIKES model
Summarise the main discussion topics
Discuss strategy for the future with the patient
Close the conversation with the option for questions
