Breaking UP Bad News Dr.Duaa Hiasat

Breaking UP Bad News Introductory course 2018 D-ARWA KHASHAN

1-What is the definition of bad news 1-What is the definition of bad news ? ( give examples) 2-Describe the sitting 3-how can you assess patients and their families perception of the medical situation? 4-how can you be empathic with the patient 5-What you must avoid in dealing with the patient ?

Objectives Define bad news Be able to describe and use SPIKE model effectively. Be committed to improve your skills in breaking bad news to the patient.

Goals 1-To gather information from the patient. (This allows to determine the patient's knowledge and expectations and readiness to hear the bad news. ) 2-To provide intelligible information in accordance with the patient's needs and desires. 3-To support the patient by employing skills to reduce the emotional impact and isolation experienced by the recipient of bad news. 4- To develop a strategy in the form of a treatment plan with the input and cooperation of the patient.

What is bad news? “any information which adversely and seriously affects an individual's view of his or her future”

If we do it badly ,the patient or family members may never forgive us ; if we do it well they may never forget us . (Buckman, 1992)

Examples of Conditions Requiring Breaking of Bad News Cancer related diagnoses Intra uterine foetal demise Life long illness: Diabetes, Epilepsy Poor prognosis related to chronic diseases: loss of independence Informing parents about their child’s serious mental/physical handicap Giving diagnosis of serious sexually transmitted disease …catastrophic psychosocial results Non clinical situations like giving feedback to poorly performing trainees or colleagues

Why is it a critical skill?    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

Spikes Setting up the interview Perceptions Invitation Knowledge Emotions Strategy/Summary

STEP 1: S—SETTING Arrange for privacy Involve significant others Sit down and appear un-hurried Make an emotional connection Make arrangements to avoid interruptions - eg. Hand off your pager if possible

STEP 2: P— PERCEPTION Use open ended questions to assess the patient and their families perception of the medical situation. Careful not to talk down or above What is your understanding of your … What have you been told so far?

STEP 3: I— INVITATION Explore if the patient wants all the facts or not. Examples of questions: how would you like me to give the information about test results? “Would you like me to give you all the information or sketch out the results and spend more time discussing the treatment plan?”.

STEP 4: K—Giving KNOWLEDGE and Information to the Patient A brief warning shot may help (Warning that bad news is coming may help lessen the shock.) Unfortunately I have some bad news to share then say it clear and concisely. Use plain language (avoid medical terms.) Get to the point. Pause. Wait for reaction.

STEP 5: E—Addressing The Patient’s Emotions with Empathic Responses Expect anything: - silence - disbelief - crying - denial - anger - shock

An empathic response consists of four steps First, observe for any emotion on the part of the patient. This may be tearfulness, a look of sadness, silence, or shock. Second, identify the emotion experienced by the patient by naming it to oneself. If a patient appears sad but is silent, use open questions to query the patient as to what they are thinking or feeling. Third, identify the reason for the emotion. This is usually connected to the bad news. However, if you are not sure, again, ask the patient. Fourth, after you have given the patient a brief period of time to express his or her feelings, let the patient know that you have connected the emotion with the reason for the emotion by making

Your Emotions Sit and listen, connect with your eyes, hold their hand Examples of empathic responses : “ I wish the news were different” “I can understand how you felt that way.” “I know this is not good news for you.” “I'm sorry to have to tell you this.” “This is very difficult for me also.”

STEP 6: S—STRATEGY and SUMMARY Make sure “the emotion part” has cleared enough for this step When ready, talk about the various treatment options Remind them that many specialists will likely be involved in their care Leave them with some kind of realistic hope. Let them know you will support them through this process.

Spikes Setting up the interview Perceptions Invitation Knowledge Emotions Strategy/Summary

What not to do ? Hurry Give all the information in one go Give too much information Use medical jargon or unclear language/words Lie or be economical with the truth Be blunt. Words can be like loaded pistols/guns Guess the prognosis (She has got 6 months, may be 7)

Final Thoughts Resolve key issues before delivering bad news Obtain relevant information before giving news Choose the appropriate setting Have support staff available Be compassionate and empathetic Be direct (don’t avoid the topic or break it slow) Be available Provide Hope (That is realistic and honest).

Thank you