L/O/G/O Tips for Breaking bad news A Critical clinical skill Prof.Mervat Atfy Mohamed Zagagazig university hospital

L/O/G/O

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:


Any news that seriously and negatively alters the patient s view to her/his future

What is Bad news?


* Help the patient and family

understand the condition *Support patient and Family

*Minimize risk of overwhelming distress

Goals


:*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?



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:


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


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


Based on this information you can correct misinformation to patient

STEP 3: I—OBTAINING THE PATIENT'S Invitation


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


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".


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


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


Respond to Empathically Emotions

Respecting…….you are asking all the

Right questions


STEP 6: S—Summary and strategy for follow up


Six step Protocol For breaking bad

Application to the Patient with Cancer news:


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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L/O/G/O Tips for Breaking bad news A Critical clinical skill Prof.Mervat Atfy Mohamed Zagagazig university hospital