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Breaking Bad News

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by

Janos Kollar

on 10 May 2014

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Transcript of Breaking Bad News

(cc) photo by Jakob Montrasio
Breaking bad news
Dr. János Kollár
assistant professor
SPIKES
Bad news: Serious and adverse impact on patient’s view of the future
Focus:
not just the medical reality but the impact on the patient
Setting:
Context and listening skills
a. Desk proxemics
b. Don’t bury your face into a file
c. Kleenex (paper tissues)
d. 45 degrees
e. 1-1.5 m distance
Non-verbal signals, for example
a. Shoulders (relaxed shoulder – down)
b. Eye contact (unless the patient is crying or angry)
Silence (not interrupting the patient) –
meanwhile: using simple frases, gestures (mhm, nodding etc)
Repetition (keywords)
Clarifying (making the patient aware that you understood him/her)
- What you're saying is…
- Let me see if I got this straight…
- Do you mean that you…
- Am I correct…
In case of interruption:
Show the patient that you are not ignoring her or him when the interruption occurs
Perception
(The patient's expectations
and perception)
How serious the patient thinks the situation is?
Use open ended before specific questions
Use reinforcement and repetition
Invitation
We’d like to know if the patient wants to know the information
Ask before you tell (don't assume).
If the patient doesn’t want to know (0.5 %) ask a relative or friend.
You should make the patient know that he/she can ask any questions even later on.
Ask permission
Knowledge
(Informing the patient)
Rules:
• Not medical jargon but plain English
• Give the information in small chunks
• Connect the chain of events so far
• Check for comprehension along the way
• Monitor response (emotions)
Emotions
(Akcnowledge emotions)
• Offer to answer questions now and later (Patients usually remember later)
• Ask if the patient wants to bring somebody next time
Summary/Strategy
Explain the bad news chronologically
(like a story)
Pitfalls:
• Poor setting or distraction
• Assuming rather than checking patient’s understanding
• Giving news in a hurry
• Responding to emotions with facts
Death of a patient –
talking with a relative
1) Begin with the relative’s perception
2) Telling the medical story of the events
(use medical facts but don’t use medical jargon)
3) Don’t forget that the relative needs EXTRA time to process the events! Use empathy!
(Pitfall: to dismiss the importance of sudden death of terminally ill patients.) Death is always a tragic event even if the death was expected.
4) Don’t let the relative alone!
Special thanks to the
Md Anderson Center
for the material used
in this lecture
...and for you for your kind
attention.
Full transcript