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Tips for Bad News Bearers

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Six Steps for Breaking Bad News. S etting up the interview ... 'The task of breaking bad news is a testing ground for the entire range of our ... – PowerPoint PPT presentation

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Title: Tips for Bad News Bearers


1
Tips for Bad News Bearers
  • A Critical Clinical Skill
  • Dr. Jeff Sisler
  • Department of Family Medicine
  • CancerCare Manitoba
  • Issues and Updates 2007

2
Learning Objectives
  • After this session, you will
  • Recognize the challenge of sharing bad news
    effectively
  • Be able to describe an effective six step
    process for sharing bad news--SPIKES
  • Be committed to improving your skills in breaking
    bad news to patients

3
What is Bad News?
  • Any news that seriously and negatively alters the
    patients view of his or her future.
  • Buckman

4
The Goal
  • Help the patient and family understand the
    condition
  • Support the patient and family
  • Minimize the risk of overwhelming distress or
    prolonged denial

5
Why is it a critical skill?
  • The Patients Perspective
  • Patients often have vivid memories of receiving
    bad news
  • Negative experiences can have lasting effects on
    anxiety and depression
  • Can facilitate adaptation to illness and deepen
    the patient-doctor relationship

6
Why is it a critical skill?
  • The Physicians Perspective
  • High degree of difficulty

    Physician anxiety
  • High risk of performing poorly

7
What do patients want?
  • For themselves
  • more time to talk
  • and show feelings
  • From the doctor
  • more information, caring,
  • hopefulness, confidence
  • a familiar face
  • Strauss 1995

8
What do you do?
  • What have you have found helpful in making bad
    news visits go as well as possible?

9
  • S etting up the interview
  • P erception of the patient re their
    illness
  • I nvitation from patient to share info
  • K nowledge and Information conveyed
  • E motions responded to empathically
  • S ummary and Strategy for follow-up

10
1. Setting up the interview
  • Anticipate the possibility of bad news, and
    arrange a follow-up visit after significant
    scans, biopsies etc.
  • Avoid telephone
  • Private setting, sitting down
  • Turn off beeper, no interruptions
  • Ensure adequate time

11
1. Setting up the interview
  • Lab reports, X-rays present
  • Support person present , if desired
  • Review the condition, basic prognosis and
    treatments before the visit
  • HOPEFUL TONE

12
The one-stop cancer website for Manitoba Family
Physicians www.cancercare.mb.ca Info for Doctors
13
Assessing the patients 2. Perception
  • ASK then TELL
  • Important if the patient is not well known to you
    OR if visits to consultants have occurred
  • Assess the Gap between what the patient knows
    and the diagnosis
  • What have you already been told about might be
    going on?
  • What is your understanding of why the CT scan
    was ordered?

14
Obtaining the patients3. Invitation
  • Preferably before the visit
  • Easier if patient is well- known
  • Listen to patient cues
  • Are you the sort of person who likes to know all
    the details of your condition?
  • Would you like me to discuss the results of the
    CT scan with you?

15
Giving 4. Knowledge and Information
  • Align yourself with the patients understanding
    and vocabulary
  • Start with a warning shot Im afraid that the
    scan shows that the problem is fairly serious.
  • Give diagnosis simply, avoid euphemisms or
    excessive bluntness
  • Provide information in small chunks
  • Check frequently for understanding

16
Giving 4. Knowledge and Information
  • Check for knowledge or experience with condition
  • Allow for pauses, use repetition
  • Will usually want basic but clear information re
    treatment plan and prognosis
  • BUT
  • Tune into patient readiness to hear more, and
    know when to stop

17
Balancing Truth and Hope The Skillful Use of
Indirect Language S Healing et al 2006
  • It looks like. not You have.
  • there are tumours in the liver not you have
    tumours in your liver
  • Emphasize on maintaining the relationship as well
    as communicating the news

18
Respond to 5. Emotions empathically
  • Observe for and allow emotional reactions
  • Kleenex handy, use of touch
  • N aming the feeling I know this is
    upsetting
  • U nderstanding It would be for anyone
  • R especting Youre asking all the right
    questions
  • S upporting Ill do everything I can to
    help you through this.

19
6. Summary and Strategy for follow-up
  • Summarize discussion
  • Clear follow-up plan re referral, tests, next
    contact (in lt48 hrs)
  • Provide written summary or brochures
  • Refer to community resources
  • Invite support person for next visit if not
    present

20
6. Summary and Strategy for follow-up
  • End on note of hope and partnership
  • AFTER document well
  • assess your own reaction

21
Six Steps for Breaking Bad News
  • S etting up the interview
  • P erception of the patient re their illness
  • I nvitation from patient to share info
  • K nowledge and Information conveyed
  • E motions responded to empathically
  • S ummary and Strategy for follow-up

22
Discrepancies in Ratings
  • Patients rated the following much higher than
    doctor and nurses
  • receiving bad news in a quiet, private place
  • arranging a follow-up visit soon to review with
    patient and family
  • inform patient about support services
  • Girgis, Behavioural Medicine 1999

23
Follow-up
  • Please take a handout outlining the SPIKES steps
    in sharing bad news
  • Try out one or two of the suggestions next time
    you have bad news to share

24
  • The task of breaking bad news is a testing
    ground for the entire range of our professional
    skills and abilities. If we do it badly, the
    patients or family members may never forgive us
    if we do it well, they will never forget us.
  • Robert Buckman

25
Thank you!
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