Tips for Breaking bad news A Critical clinical skill Prof.Mervat Atfy

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Tips for Breaking bad news
A Critical clinical skill
Prof.Mervat Atfy Mohamed
L/O/G/O
l
Learning objectives:
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
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What is Bad news?
Any news that seriously and
negatively alters the patient s
view to her/his future
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Goals
*Help the patient and family
understand the condition
*Support patient and Family
*Minimize risk of
overwhelming distress
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Why it is critical skill?
*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
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Why it is critical skill?
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What do patients want?
For themselves
*More time to talk
and show feelings
From Doctors
More information, caring.
Confidence ,hopefulness,
Familiar face
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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
Based on this information you can
correct misinformation to patient
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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
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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...".
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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
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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
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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
Understanding ……..it would be for any one
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Respond to
Emotions Empathically
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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