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Breaking Bad News - PowerPoint

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					Breaking Bad News
What is Bad News ?

• Any news that drastically alters a patient’s
 view of his or her future
Why Is It Difficult to Do

• Worry that the news will cause an adverse
  effect
• Worry that it will be difficult to handle the
  reaction of patient or family
• Challenge of individualizing the approach
What Do Patient’s Want?

• Studies show that 50-90% of patients with
  terminal illnesses want full disclosure
• Not everyone wants to know
How Should Bad News Be Delivered?

• ABCDE Mneumonic
• A-Advance Preparation
• B-Build a therapeutic relationship
• C-Communicate well
• D-Deal with patient and family reactions
• E-Encourage and validate emotions
Advance Preparation
• Familiarize with the facts of the case, consultant
    opinions, prognosis and treatment options
•   Arrange for appropriate environment and time
    where there will be no interruptions (silence
    beeper and cell phone)
•   Mentally rehearse how you will deliver the news
•   Prepare emotionally
Advance Preparation
• Familiarize with the facts of the case, consultant
    opinions, prognosis and treatment options
•   Arrange for appropriate environment and time
    where there will be no interruptions (silence
    beeper and cell phone)
•   Mentally rehearse how you will deliver the news
•   Prepare emotionally
Build a Therapeutic Relationship

• Determine what the patient wants to know
• Have family or other supporters present
  based upon patient preference
• Introduce yourself to everyone present
• Foreshadow the bad news
• Assure the patient that you will be
  available-schedule a follow-up meeting
Communicate Well

• Find out what they know
• Speak clearly-avoid euphemisms like
  “growth”
• Allow silences-proceed at the patient’s
  pace
• Assess understanding
• Summarize and make followup plans
Types of Ambiguous Communication

• Jargon and technical language
• Euphemisms
• Evasion
• Conflicting information
• Percentages and statistics
• Obfuscation
Example

• Physician: As you may remember, when
  we first started chemotherapy, we told
  you that we would check blood and x-rays
  before each cycle. I have looked at your
  scans today and there are signs that
  things are progressing, so we do not think
  that you should have any more chemo
• Patient: So what happens now?
• Physician: Well, we just want you to come
 back and see us if you develop any further
 problems with your breathing and we will
 treat those symptoms
• The researcher met with the patient after
 this conversation and his interpretation of
 what the physician told him was “Well it’s
 good news, really…the doctor thinks
 things are progressing so I don’t need any
 more chemo and to just come back if my
 breathing starts up again-getting
 breathless you know”
Deal with patient and family reactions

• Assess and respond to emotional reactions
• Be empathetic-I’m sorry that I couldn’t
  give you better news
• Avoid criticizing colleagues
Encourage and Validate Emotions

• Offer realistic hope
• Offer referals as needed
• Use interdisciplinary services to enhance
  care
• Take care of own needs and others
  affected by the news
Other Pointers

• Avoid telephone notification
• Be a good listener
• Respect preferences
In a meeting

• Find out who everyone is
• Determine what they know
• Determine what they want to know
• Tell
• Respond
• Plan future meetings
Ten Important Needs of Families of
Critically Ill Patients
•   Be with the patient
•   Be helpful to the patient
•   Be informed of changes in condition
•   Understand what is being done and why
•   Be assured of the patient’s comfort
•   To be able to ventilate emotions
•   To be assured that their decisions were right
•   Find meaning in the dying of their loved one
•   To be fed, hydrated and get rest
Death Notification
• Prefer to be told by the physician
• Ask the family members what they know about
    the situation
•   Bridge from what they know with a brief
    description of what happened
•   Give information about the resuscitative efforts
•   Conclude with the victim’s response, the
    statement of death and an assessment of the
    cause of death

				
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posted:2/24/2010
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