1. Breaking UP Bad News
Dr.Duaa Hiasat

2. Breaking UP Bad News
Introductory course
2018
D-ARWA KHASHAN

3. 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 ?

4. 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.

5. 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.

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

7. 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)

8. 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

9. 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

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

11. 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

12. 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?

13. 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?”.

14. 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.

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

16. 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

17. 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.”

18. 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.

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

20. 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)

21. 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).

22. Thank you