Communication Skills in Medicine - Delivering Bad News An Introduction to Internet Resources in English - PowerPoint PPT Presentation

Loading...

PPT – Communication Skills in Medicine - Delivering Bad News An Introduction to Internet Resources in English PowerPoint presentation | free to download - id: 537f10-MTUxN



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Communication Skills in Medicine - Delivering Bad News An Introduction to Internet Resources in English

Description:

Communication Skills in Medicine - Delivering Bad News An Introduction to Internet Resources in English Podzim 02 - pindler v Ml n Pavel Kurf rst, CJ LF UP – PowerPoint PPT presentation

Number of Views:291
Avg rating:3.0/5.0
Slides: 31
Provided by: Pav948
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Communication Skills in Medicine - Delivering Bad News An Introduction to Internet Resources in English


1
Communication Skills in Medicine - Delivering Bad
News An Introduction to Internet Resources in
English
  • Podzim 02 - Špindleruv Mlýn
  • Pavel Kurfürst, ÚCJ LF UP

2
BAD NEWS
  • any news that drastically and negatively alters
    the patients view of his or her
    future (Vandekieft)
  • it results in a cognitive, behavioral, or
    emotional deficit in the person receiving the
    news that persists for some time after the news
    is received (Back Curtis)

3
BAD NEWS
  • many health care professionals tend to define
    'bad news' as worst case scenarios (eg. telling a
    patient they have cancer or that their loved one
    has died)
  • but a knee cartilage problem requiring rest for a
    waitress may mean no pay (RFC handbook)

4
SITUATIONS
  • terminal diagnosis
  • death in an out-of-hospital setting
  • communicating sensitive subjects to parents and
    children
  • fetal death verified by an ultrasound
  • multiple sclerosis confirmed by MRI
  • onset of diabetes in an adolescent

5
THE PAST AND THE PRESENT
  • Hippocrates advised concealing most things from
    the patient
  • older physicians, who trained during the 1950s
    and 60s, were taughtto "protect" patients from
    disheartening news (Easton)
  • in the past decades traditional paternalistic
    models of patient care have given way to an
    emphasis on patient autonomy

6
FACTS
  • 50-90 of patients desire full disclosure of a
    terminal diagnosis (Vandekieft)
  • 95 of cancer patients want the physician to be
    fully honest with them about the outcome of their
    illness (Thomas)

7
FACTS
  • over the course of a 40-year career, an
    oncologist may conduct up to 200,000 interviews
    with patients, caregivers and/or families if as
    few as 10 of those interviews involve the
    disclosure of bad news, that is still 20,000
    interviews in which you have to be the bearer of
    bad news (Buckman)

8
EDUCATION
  • clinicians are responsible for delivering bad
    news, this skill is rarely taught in medical
    schools, clinicians are generally poor at
    it (Rabow McPhee)
  • breaking bad news is one of a physicians most
    difficult duties
  • medical education typically offers little formal
    preparation for this task (Vandekieft)

9
EDUCATION
  • 1997-1998 AMA survey only 4 of 126 US medical
    schools required a separate course on caring for
    the dying (Acevedo)
  • many medical graduates have persisting
    interpersonal difficulties when confronted with
    terminally ill patients, death and dying
    (Barrington Murrie)

10
EDUCATION
  • historically, the emphasis on the biomedical
    model in medical training places more value on
    technical proficiency than on communication
    skills

11
  • in ancient times, the bearer of the news that a
    battle had been lost was often killed in a
    similar fashion, reacting to bad news, some
    patients blame their clinicians (Rabow McPhee)
  • death represents a failure of the medical system,
    our failure as physicians, and even our failure
    as human beings (West)

12
  • clinicians focus often on relieving patients'
    bodily pain, less often on their emotional
    distress, seldom on their suffering
  • they may view suffering as beyond their
    professional responsibilities
  • if clinicians feel unable to, or simply do not
    want to, address the powerful issue of patient
    suffering, it is appropriate to refer the
    patient to another professional on the healthcare
    team who is more comfortable in this arena (Rabow
    McPhee)

13
  • breaking bad news is not as much a delivery as it
    is a dialogue between two people (Rabow
    McPhee)
  • the patients needs to given an opportunity to
    express his emotions and to articulate his
    fears (Thomas)

14
  • the physicians caring attitude is more important
    than the information provided during the clinical
    encounter (Back Curtis)
  • clinicians can deliver bad news well and manage
    its consequences (Rabow McPhee)

15
COMMUNICATE AS A TEAM
  • patient
  • family
  • physician
  • other health care providers
  • psychologist
  • chaplain
  • nurse
  • social worker
  • translator

16
GUIDELINES
  • several professional groups have published
    consensus guidelines on how to discuss bad news
  • few of those guidelines are evidence-based
  • the clinical efficacy of many standard
    recommendations has not been empirically
    demonstrated (Vandekieft)

17
S-P-I-K-E-S
  • a six-step approach by R. Buckman
  • proposed by the Project to Educate Physicians on
    End-of-life Care (EPEC) - supported by the
    American Medical Association and the Robert
    Wood Johnson Foundation

18
S-P-I-K-E-S
  • setting
  • perception
  • invitation
  • knowledge
  • empathy
  • strategy and Summary
  • (Buckman Maicki Acevedo Payne EPEC materials
    Michigan PG)

19
ABCDE
  • advance preparation
  • build a therapeutic environment/relationship
  • communicate well
  • deal with patient and family reactions
  • encourage and validate emotions (reflect back
    emotions)
  • (Rabow McPhee Vandekieft Dyer)

20
OTHER GUIDELINES
  • preparation
  • place
  • people
  • position
  • pronouncement
  • post-event follow up
  • (Rodgers)

21
OTHER GUIDELINES
  • preparation
  • introduction
  • achieving understanding
  • pacing and shared control
  • (Rodgers)
  • responding to emotions
  • honesty
  • support
  • closure

22
OTHER GUIDELINES
  • preparation
  • setting
  • delivery
  • emotional Support
  • information
  • closure
  • (Gordon)

23
OTHER GUIDELINES
  • prepare for the encounter
  • assess the patients understanding
  • discuss the news
  • respond to the patients emotions
  • offer to discuss implications of the news
  • summarize the discussion
  • arrange a follow-up time for patient and family
    questions and concerns
  • document the discussion in the medical record
  • (Back Curtis)

24
OTHER GUIDELINES
  • the World Health Organisation (WHO) Guidelines on
    Communicating Bad News
  • WHO/MNH/PSF/93.2.B
  • (WHO Guidelines on Communicating Bad News -
    adapted abstract)

25
REMEMBER
  • people handle information differently
  • depending on their
  • educational level
  • ethnicity and culture
  • religion, beliefs
  • socioeconomic status
  • age
  • (Michigan Physician Guide)

26
REMEMBER
  • technical language usually misunderstood by the
    patient (73 of women with breast cancer do not
    understand the term MEDIAN when told about
    prognosis and survival) (Back - Curtis)
  • avoid euphemisms
  • do not minimize the severity of the
    situation (Michigan Physician Guide)

27
REMEMBER
  • never give bad news on a Friday!
  • (RFC handbook)

28
KEY WORDS
  • communicating / delivering / breaking / giving
    bad news
  • communication skills / communication issues /
    doctor-patient communication
  • end-of-life care / palliative care / palliative
    medicine
  • end-of-life communication

29
RESOURCES
  • see a separate list of resources
  • click here (.rtf file)

30
CONTACT
  • kurfurst_at_seznam.cz
  • www.ucjlf.upol.cz/svoc
About PowerShow.com