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Tips for Breaking bad newsA Critical clinical skillProf.Mervat Atfy Mohamed
Tips for Breaking bad newsA Critical clinical skillProf.Mervat Atfy Mohamed
Zagagazig university hospital
www.themegallery.com
After this session, you will:*Recognize challenge to share bad
news effectively
*Be able to describe an effectively six steps process to share bad news-SPIKES .Application to the Patient with Cancer
Be committed to improving your * skills in breaking bad news to patient
Learning objectives:
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Any news that seriously and negatively alters the patient s view to her/his future
What is Bad news?
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* Help the patient and family
understand the condition *Support patient and Family
*Minimize risk of overwhelming distress
Goals
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:*The physician perspective
high degree of difficult +
physician anxiety
=High risk of performing poorly.
When physicians are uncomfortable in giving bad news they may avoid discussing distressing information, such as a poor prognosis
Why it is critical skill?
Why it is critical skill?
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For themselves
*More time to talk
and show feelings
From Doctors More information, caring.Confidence ,hopefulness,
Familiar face
What do patients want?
Six step Protocol For breaking bad Application to the Patient with Cancer news:
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STEP 1: S :Setting up The interview
*Private setting, sitting down
*No telephone, turn off mobile ,no interruptions
* Ensure adequate time
*Review the condition ,lab, basic prognosis and treatment before visit
*Hopeful tone
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STEP 2: P—ASSESSING THE PATIENT'S Perception
"before you tell, ask".* Assess the gap between what the
patient knows and diagnosis. *What have been told about what are
going on?* What is your understanding why the CT
scan was ordered?
Mervat atfy mohamed
STEP 2: P—ASSESSING THE PATIENT'S Perception
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Based on this information you can correct misinformation to patient
STEP 3: I—OBTAINING THE PATIENT'S Invitation
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While a majority of patients express a desire for full information about their diagnosis, prognosis, and details
of their illness, some patients do not
STEP 4: K—GIVING KNOWLEDGE AND INFORMATION TO THE PATIENT
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Warning the patient that bad news is coming may lessen the shock that can follow the disclosure of bad news and may facilitate information processing. Examples of phrases that can be used include,
"Unfortunately I've got some bad news to tell
you“ or "I'm sorry to tell you that...".
STEP 4: K—GIVING KNOWLEDGE AND INFORMATION TO THE PATIENT
•Try to use nontechnical words such as "spread" instead of "metastasized" and
•"sample of tissue" instead of "biopsy".
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Avoid excessive bluntness (e.g., "You have very bad cancer and unless you get treatment immediately you
are going to die.") as it is likely to leave the patient isolated and later angry, with a tendency to blame the
messenger of the bad news
Balanced truth and Hope :skillful use of indirect language
As ( it is look like) not (you have..…(There are tumours in the liver ) )not you
have tumor in your liver
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when the prognosis is poor, avoid using phrases such as "There is nothing more
we can do for you." This attitude is inconsistent with the fact that patients often have other important therapeutic goals such as good pain control and
symptom relief
STEP 5: E—ADDRESSING THE PATIENT'S EMOTIONS WITH EMPATHIC RESPONSES
*Observe for and allow all emotional reaction
* Use touch Name the feelings….. I know this is upsetting
..……it would be for any one Understanding
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Respond to Empathically Emotions
Respecting…….you are asking all the
Right questions
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STEP 6: S—Summary and strategy for follow up
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Six step Protocol For breaking bad
Application to the Patient with Cancer news:
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At the end
The task of breaking bad news is testing ground for entire
range of our professional skills. if we do it badly patients
and family will never forgive us,
if we do it well patients and their family never forget us
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