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COMMUNICATION SKILL & BREAKING BAD NEWS
Mohammad Tanvir Islam
WHAT IS A COMMUNICATION?? “ the process of passing information and
understanding from one person to another it is essentially a bridge of meaning between the people by using the bridge a person can safely cross the river of miss understanding “
Keith Davis
7CS OF COMMUNICATION
1. Candid2. Clear3. Complete4. Concise 5. Concrete6. Correct 7. Courteous
BARRIER TO COMMUNICATION SKILL
TYPES OF BARRIERS Semantic barriers Physical barriers Organizational barriers Psychological barriers
SEMANTIC BARRIERS Different language Different context for words and
symbols Poor vocabulary
মুদ্রা দ�াষ = Coin Fault মুদ্রা দ�াষ = অঙ্গ ভঙ্গিঙ্গ
PHYSICAL BARRIERS
TYPES OF PHYSICAL BARRIER
1. Noise 2. Improper time 3. Distance 4. Inadequate or overload information
ORGANIZATIONAL BARRIERS Organizational barriers occurs in the
organization due to rules ,regulation and hierarchical relationship .
TYPES OF ORGANIZATIONAL BARRIERS
1. Rules and regulations2. Hierarchical relationship
PSYCHOLOGICAL BARRIERS
TYPES OF PSYCHOLOGICAL BARRIERS1. Selective perceptions2. Premature evaluation3. Poor listening 4. Attitude of superiors5. emotions
BREAKING BAD NEWS
“any information which adversely and seriously affects an individual's view of his or her future”
What is a bad news??
WHAT ARE THE BAD NEWS?
Unfavourable diagnosis Irreversible, un-treatable, or non-
stoppable diseases (or side effects, or complications)
disease recurrencespread of diseaserevealing positive results of genetic tests StigmatizationLate (to treat) stage diseases End of life decisionsDeath
PATIENTS DESIRE Less than 10% patients do not want to know their
illness 90% want to know about their illness 30% want to know the exact name of their illness Almost 100% want to know the “chance of a cure”
WHY SHOULD WE CARE? Ethical Professional Human rights Legal
PRACTICAL APPROACHES TO BBN
SPIKES ABCDE BREAKSSetting and Listening SkillsPatient PerceptionInvitation to Give InformationKnowledgeExplore Emotions & EmpathizeStrategy and Summarize
A- Advance PreparationB- Build environment/ relationshipC- Communicate wellD- Deal with reactionsE- Encourage & validate emotions
B – Background R – Rapport E – Explore A – AnnounceK – KindlingS – Summarize
SP IKES
STEP 1: S—SETTING UP THE INTERVIEW
Arrange for some privacy Involve significant others (family, relatives) Sit down Make connection with the patient Manage time constrain & interruption
ARRANGE FOR PRIVACY
Click icon to add picture
Think 5 seconds before you comment!
INVOLVE SIGNIFICANT OTHERS
SIT DOWN WHILE YOU TALK
MAKE CONNECTION WITH THE PATIENT
STEP 2P- ASSESSING THE PATIENT’SPERCEPTION
The InterviewThe Interview
Open-ended questions to create a reasonably accurate picture of
“how the patient perceives the medical situation”
STEP 3: I—OBTAINING THE PATIENT’SINVITATION Would you like me to give you all the
information Offer to answer any questions they may
have in the future or To talk to a relative or friend
STEP 4: K— GIVING KNOWLEDGE ANDINFORMATION TO THE PATIENT
“Unfortunately I’ve got some bad news to tell you” or “I’m sorry to tell you that…”.
WARNING THE PATIENT THAT BAD NEWS IS COMING………
HOW TO GIVE INFORMATIONS Start at the level of comprehension and
vocabulary of the patient Try to use nontechnical words such as
“spread” instead of “metastasized” and “sample of tissue” instead of “biopsy”
Avoid excessive bluntness (e.g., “You have very bad cancer and unless you get treatment immediately you are going to die”)
Give information in small chunks and check periodically as to the patient’s understanding
When the prognosis is poor, avoid using phrases such as “There is nothing more we can do for you.”
STEP 5: E—ADDRESSING THE PATIENT’SEMOTIONS WITH EMPATHIC RESPONSESPatients’ emotional reactions may vary
from silence disbelief Crying denial, or anger
AN EMPATHICRESPONSE CONSISTS OF FOUR STEPS
1. Observe for any emotion on the part of the patient
2. Identify the emotion experienced by the patient by using open questions to query the patient as to what they are thinking or feeling
3. Identify the reason for the emotion 4. Let the patient know that you have
connected the emotion by making a connecting statement.
If the emotion does not diminish shortly, it is helpful to continue to make empathic responses until the patient becomes calm
STEP 6: S—STRATEGY AND SUMMARY Patients who have a clear plan for the
future are less likely to feel anxious and uncertain
Ask the patients if they are ready for such a discussion
Present treatment options Share treatment responsibility with
patient
SP IKES
S= Setting P=Perception I=Invitation K=Knowledge E= Empathic S= Strategy & Summery
BARRIER TO BBN
I don’t know how much I could communicate with you………………
But
Thank you for being a good listener
Thank you