1. COMMUNICATING BAD NEWS

2. WHAT IS BAD NEWS?

3. DEATH, DYING, MOURNING DEATH IS THE ONLY DEMOCRATIC INSTITUTION OF THE WORLD (Gilgames epos- Godness Istar) DEATH IS THE ONLY DEMOCRATIC INSTITUTION OF THE WORLD (Gilgames epos- Godness Istar) In the past time it was the natural part of the life (rituals, death watch, saying good bye, relatives, funeral meal) In the past time it was the natural part of the life (rituals, death watch, saying good bye, relatives, funeral meal) Today it happens mostly in hospitals (loosing personality, dignity) Today it happens mostly in hospitals (loosing personality, dignity) Nowadays people are not able to speak about death Nowadays people are not able to speak about death Its threatening (TV-mass death-it can happen to others but not us, protect our children from funerals, seeing death) Its threatening (TV-mass death-it can happen to others but not us, protect our children from funerals, seeing death)

4. FACTS Basic skill – doctor-patient relationship Basic skill – doctor-patient relationship Doctors are unprepared Doctors are unprepared Changes in the last years Changes in the last years From paternalistic to partner relationship From paternalistic to partner relationship Rights of the patients Rights of the patients Increased need of patients to KNOW Increased need of patients to KNOW Increased knowledge and understanding of patients Increased knowledge and understanding of patients The role of media (magazines, internet..) The role of media (magazines, internet..) Need for change Need for change

5. COMMUNICATING BAD NEWS Kath Donovan: Communicating Bad News, 1993 Kath Donovan: Communicating Bad News, 1993 Do the physicians inform the patients properly? Do the physicians inform the patients properly?

6. DIFFERENT MODELS OF COMMUNICATING BAD NEWS Model doctor-patient relationship Who makes the decision? doctor-patient communication no information paternalistic only the doctor insufficient every peace of information paternalistic only the patient good enough Individual way of informing the patient partnertogethergood

7. INDIVIDUAL INFORMATION Patients differs in.. Patients differs in.. How much information they can take How much information they can take How much time they need How much time they need The way they are able to cope The way they are able to cope How much they trust the doctor (doctor- patient relationship) How much they trust the doctor (doctor- patient relationship) So it TAKES TIME So it TAKES TIME And it must be GRADUAL And it must be GRADUAL

8. How much information does the patient need at that specific situation? How much information does the patient need at that specific situation? How can we inform the patient? How can we inform the patient?

9. PREPARING after you are assured about the diagnosis after you are assured about the diagnosis timing - ideal circumstances timing - ideal circumstances personal – never on the phone personal – never on the phone restful place restful place enough time to talk enough time to talk who else can be present who else can be present the weight of the word of cancer the weight of the word of cancer

10. HOW MUCH DOES THE PATIENT KNOW? HOW MUCH DOES THE PATIENT KNOW? HOW MUCH DOES THE PATIENT WANT TO KNOW? HOW MUCH DOES THE PATIENT WANT TO KNOW?

11. INFORMING THE PATIENT SINCERENESS – TRUST SINCERENESS – TRUST EMPATHETIC BUT STRAIGHT EMPATHETIC BUT STRAIGHT GRADUAL (the patients mood) GRADUAL (the patients mood) UNDERSTANDABLE (simple words, no jargon-it is cancer) UNDERSTANDABLE (simple words, no jargon-it is cancer) CHECK IF THE PATIENT UNDERSTOOD US CHECK IF THE PATIENT UNDERSTOOD US NON VERBAL COMMUNICATION NON VERBAL COMMUNICATION GIVE SUPPORT GIVE SUPPORT

12. THE PATIENTS REACTIONS Very different: Very different: full of emotions: crying, anger, relief silence, sadness BE COMPASSIONATE AND OPEN LISTEN TO THE PATIENT

13. PLANNING AND THE FOLLOW- UP strategy strategy treating the actual complaints treating the actual complaints supporting the patient physically and mentally supporting the patient physically and mentally the next appointment the next appointment access to us access to us

14. 12 STEPS 1. Choose restful place 2. Be personal 3. Take enough time to talk 4. Use simple, understandable words 5. Dont belittle, dont reduce the problem 6. Estimate the status, the mood of the patient 7. Show empathy 8. Look for the patients reactions 9. Assure the patient of your support 10. Inform the patient about the possible procedures 11. Let the patient ask questions 12. Make new appointment

15. The doctor has to be able: The doctor has to be able: To be sincere and clear To be sincere and clear To give the required time and information To give the required time and information To give support and help To give support and help To give real hope To give real hope To build up a proper and secure D-P realtionship To build up a proper and secure D-P realtionship The doctor has to percept: The doctor has to percept: The patients fear and struggle and axiety The patients fear and struggle and axiety His /her own limits of medical knowledge His /her own limits of medical knowledge

16. The physician should be able to help the people to live till their death protecting them from the huge and unbearable fear of death which would destroy the rest of their life. The physician should be able to help the people to live till their death protecting them from the huge and unbearable fear of death which would destroy the rest of their life.(Parker)