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Published byLester Davis Modified over 6 years ago
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Dr Sara Matley – Consultant Clinical Psychologist, LGI
Dr Rachel Avison – Senior Clinical Psychologist, LGI
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Introductions Dr Sara Matley Mrs Jayne Slack
Senior Counsellor Dr Sara Matley Consultant Clinical Psychologist Dr Rachel Avison Senior Clinical Psychologist Dr Nadia Khurram Clinical Psychologist Sandie Allison Counsellor
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On a lighter note…
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On a more professional note…
1. Everyone here will have: Delivered bad news Observed someone receiving bad news Experienced bad news first hand 2. Whether bad news is delivered or received, it can be a difficult and emotive experience for all 3. As a result, look after yourself. If you need to step out it’s fine to do so
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Breaking bad news well Patient/ Carer Professional Influences…
- Emotional health & adjustment - Physiological health (e.g. blood pressure, pain) Influences… - Emotional health (e.g. stress, burden, burn out) - Physiological health Patient/ Carer Professional
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What helps? A structure Kaye’s 10 step approach - Kaye (1999)
SPIKES model - Baile & Buckman (2000) ABCDE mnemonic - Rabow & McPhee (2000) Communication Preparation Planning Follow up
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Prepare the patient/ family
1. Preparation Prepare yourself Prepare the setting Prepare the patient/ family
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Prepare Yourself High anxiety normal Avoidance common
Remember, the news may be very sad but having info allows patients/ families to plan & process Take time - review patient info & plan what to say More contained, better experience for all Take a colleague if possible
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Prepare the setting Ensure protected time
Privacy – a quiet room ideal, if not, make space ‘Do not disturb’ All sit down, no barriers between you Handover phones/ bleeps Tissues, water nearby
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Prepare the patient/ family
Is the patient/family ready to receive difficult news? Child present? Their Developmental level? Communication needs? Signer, interpreter, support worker Any religious, cultural, ethical views?
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Prepare the patient/ family
Before you tell, ask. What does the patient/ family know already? Denial, wishful thinking, unrealistic expectations? Obtain permission to have a conversation Share that difficult news is coming Start with the facts, minimal technical language Give the info in small sections Pause throughout to allow processing
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2. Communication Rapport – eye contact, emotional warmth, summarise, ask questions, open, honest communication Look for cues Less sympathetic statements – ‘I’m sorry about this’ ‘I understand’ ‘I know this is very sad’ More empathic statements - ‘this will be very difficult news for you to hear’ ‘it’s a really tough situation’ ‘this is very sad’ Silence is important, no need to fill gaps, take time ‘Sit with’ rather than fix - hold back with advice. Reassurance can be unhelpful
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3. Planning End the conversation with a summary
Ask patient/ family what would help Then make recommendations/ suggestions about support Arrange a follow up conversation - very likely the patient/ family may not recall the details of the conversation (20%)
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4. Follow up Debrief and reflect Document the conversation
Work as a team in exploring support options, e.g. CNS contact, Psychology referral, Play Specialist input, Childrens Heart Surgery Fund Summarise the discussion and support plan in writing if required Supervision & mentoring
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Psychological Continuum
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Thank you for listening! Any questions, comments, thoughts?
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References Baile W et al. (2000) SPIKES – a six-step protocol for delivering bad news: application to the patient with cancer, Oncologist, 5, pp Kaye P (1996) Breaking bad news: A 10 step approach, Northampton: EPL Rabow MW & McPhee SJ (1999) Beyond breaking bad news: How to help patients who suffer, Western Journal of Medicine, 171, pp Royal College of Nursing Guidance document (2013) Breaking bad news: Supporting parents when they are told of their child’s diagnosis. University Hospital of South Manchester - Sage & Thyme Training
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