Delivering Bad News in Healthcare

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Questions and Answers

What percentage of patients want to know the exact name of their illness?

70%

30% (correct)

50%

90%

What is one of the barriers to delivering bad news in a clinic?

Poor lighting

Lack of patient's autonomy

Inadequate time (correct)

Overuse of technical jargon

What is the 'P' in the Six steps of SPIKES?

Privacy

People

Perceptions (correct)

Perception

Why is delivering bad news difficult for healthcare providers?

All of the above Signup and view all the answers

What is cultural identity?

Each individual's values, traditions, beliefs, and expectations through a synthesis of their different groups Signup and view all the answers

What should a healthcare provider do during the 'Emotions' step of the Six steps of SPIKES?

Show empathy and acknowledge the patient's emotion Signup and view all the answers

What is an example of bad news that may seriously affect a person's view of their future?

Presence of a suspicious lesion Signup and view all the answers

What is one of the general techniques for improving the delivery of bad news?

Using a caring voice Signup and view all the answers

What is the primary focus of Person-Centered Care?

Person in context of personal, social, religious, and ethnic factors Signup and view all the answers

What is the Quadruple Aim of Person-Centered Care?

Improve patient experience, improve provider experience, optimize costs, improve public health Signup and view all the answers

What is the Life-Course Approach for Oral Health Care?

Considers factors that act during development and aging that might influence disease onset Signup and view all the answers

What is Big Data?

Data that is so large, fast, or complex that it is difficult or impossible to process using traditional methods Signup and view all the answers

What is the primary goal of AIDPH?

To advance oral health through science, education, and advocacy Signup and view all the answers

What is the percentage of adults that struggle with health literacy?

90% Signup and view all the answers

What is the primary consequence of low health literacy?

Poorer health outcomes Signup and view all the answers

What is the primary strategy for addressing health literacy?

Create a shame-free environment Signup and view all the answers

What is the primary goal of SPIKES in dentistry?

To deliver bad news in dentistry Signup and view all the answers

What is the eligibility criteria for VA dental clinics?

Only for veterans who are eligible for dental care through the VA Signup and view all the answers

What is the primary focus of cultural competency in healthcare?

Attaining skills, knowledge, and attitudes to work effectively with patients from diverse cultures Signup and view all the answers

What is the estimated percentage of individuals living with mental health disorders?

1 in 5 Signup and view all the answers

Which of the following is NOT a strategy for achieving culturally congruent communication?

Assuming the patient's cultural background Signup and view all the answers

What is the primary goal of trauma-informed care?

To deliver services grounded in an understanding of the impact of trauma Signup and view all the answers

What is the estimated percentage of people with untreated caries?

13-25% Signup and view all the answers

Which of the following models of care emphasizes overall respect for patients' values, preferences, and expressed needs?

Pickler model Signup and view all the answers

What is the estimated percentage of people with dental fear?

149 million people (or half of the population) Signup and view all the answers

What is the primary focus of cultural awareness in healthcare?

Identifying one's own cultural background, values, and beliefs Signup and view all the answers

Which of the following is a strategy for compassionate care?

Humility and collaboration Signup and view all the answers

What is the primary focus of the Four R's framework in trauma-informed care?

Integrating knowledge about trauma into policies and practices Signup and view all the answers

What is the primary difference between fear and anxiety in the context of dental situations?

Fear is a response to the dental situation, while anxiety is a feeling of apprehension about the situation Signup and view all the answers

Which of the following is a cause of dental fear?

All of the above Signup and view all the answers

What is the primary goal of assessing the level of dental fear?

To develop a management plan for dental fear Signup and view all the answers

Which of the following is NOT a type of healthcare professional who can diagnose and treat mental illness?

Dentist Signup and view all the answers

What is the definition of gender that recognizes the emotional, psychological, and social traits that describe an individual as androgynous, masculine, or feminine?

Good definition Signup and view all the answers

According to LGBTQ health data, what is the experience of transgender people compared to cisgender people?

2.5 times the violence Signup and view all the answers

What is a challenge faced by transgender patients on gender-affirming therapy?

Erythrocytosis and acne Signup and view all the answers

What is a strategy for inclusivity in healthcare settings?

Using inclusive language and communication Signup and view all the answers

What is the primary goal of conative restructuring in managing dental fear?

To change the patient's thought patterns and behaviors Signup and view all the answers

What is the benefit of exposure therapies in managing dental fear?

To gradually desensitize the patient to the feared stimuli Signup and view all the answers

Study Notes

Person Centered Care Overview

Definition: A way of thinking and doing things that sees people using health care services as equal partners in planning, developing, and monitoring care to meet their needs.
Key elements:
- Person First, patient second
- Provider as a person
- Persons/families at the center of treatment decisions
- Persons as experts
- Providers guide patients through good information
- Providers deliver services patients cannot perform
Quadruple aim of person-centered care:
- Improve patient experience
- Improve provider experience
- Optimize costs/value
- Improve public health
Three elements of providers' considerations for patients:
- Understanding
- Decision making
- Intervening

Approaches to Care

Student-centered care:
- Focuses on student provider gaining experiences
- Patients' ability to pay
- Patient is meant to perform specific procedures
Patient-centered care:
- Focuses on patient during individual visits
- Management of disease
- Body systems are separate from each other and separate from psychological domain
Person-centered care:
- Focuses on person in context of personal, social, religious, and ethnic factors in a holistic fashion
- Future: Offering flexible telehealth, homecare, microbiome analysis, and integrated health information

Life-Course Approach

Considers factors that act during development and aging that might influence disease onset
Framework: Risk accumulation and sensitive periods of exposure with underlying socio-environmental determinants
Pregnancy and postpartum oral health:
- Perio disease associated with preeclampsia, increased risk of preterm birth, and low infant birth rate
- Dental care is safe during pregnancy
Childhood oral health:
- Fighting against "Primary teeth will fall out anyway" mentality
- Early childhood caries are the most common childhood chronic disease
- Linked to poor nutrition, weight loss, iron deficiency, and negative impact on child's behavior, school performance, and overall development
Adolescence oral health:
- Becoming more independent from parents
- Vaping becomes common, increasing risk of periodontal disease and oral lesions
- Potential injuries from athletics
- Piercings
- Lots of sugar
Young adulthood oral health:
- Introduction of tobacco and alcohol
- Increases risks of oral cancer, pulmonary and cardiovascular disease, and depression
Oral health during middle age:
- Perio disease is a significant concern
- Bidirectional relationship between periodontal disease and diabetes
Oral health during adulthood:
- Perio disease association with dementia
- Risk of hospital-acquired pneumonia is higher with missing teeth and heavy plaque

Adverse Childhood Experiences (ACEs)

Just under half of US children have experienced at least one ACE
ACE exposure is linked to dental caries, bleeding gums, tooth loss, periodontal disease, and dental pain

Big Data and Person-Centered Care

Definition: Data that is so large, fast, or complex that it is difficult or impossible to process using traditional methods
Three V's of Big Data:
- Volume
- Velocity
- Variety
Big data challenges:
- Minority communities hesitate to participate in big data research (privacy concerns, longstanding abuse)
- Present-day concerns (hacking/security breaches)
Recommendations for Big Data:
- Incorporate standardized collection for classifications (race/ethnicity, etc.) for all systems collecting big data
- Enhance surveillance for geographic variables and social determinants of health
- Advance simulation modeling
- Build trust to avoid "big brother" perception
- Invest in data collection in small populations
- Encourage data sharing
- Promote data science in training programs for underrepresented societies
- Assure active efforts are made upfront during both the planning and implementing stages of new big data resources to address disparities reduction

Veterans

AIDPH mission statement: Empowering community to advance oral health through science, education, and advocacy
AIDPH vision statement: A justice-oriented oral health system
AIDPH communities of focus:
- LGBTQIA+
- Veterans
- Disabilities
- Rural
Funding for Veteran dental benefits: Congress through Title 38 of Federal code
Eligibility for VA dental clinics: Only for veterans who are eligible for dental care through the VA
Recommendations for improving dental care for veterans:
- Expand eligibility criteria for veterans
- Advance integrated care for veterans
- Expand FQHCs and rural access clinics
- Prioritize trauma-informed care
- Improve data collection for oral health indicators

Health Literacy

Definition: An individual's ability to obtain, understand, and use health information to make appropriate health decisions
Percentage of adults that struggle with health literacy: 90%
Complications to accessing health care:
- Applying for and understanding insurance
- Finding providers
- Understanding automated telephone menu systems
- Navigating referrals
- Following chronic disease management programs
Impact of low health literacy:
- Poorer health outcomes
- Increased hospitalizations
- Greater use of emergency care
- Difficulty understanding medication instructions and warning labels
- Higher health care costs
Red flags for low health literacy:
- Frequently missing appointments
- Forgetting glasses at home
- Getting angry or impatient
- Problems with medications
- Difficulties filing out admission/intake forms
- Taking written materials home for someone else to review
- Not asking questions
Strategies for addressing health literacy:
- Create a shame-free environment
- Use plain language and clearly written materials
- Use the teach-back method

SPIKES

What is bad news in dentistry: Any information that adversely and seriously affects a person's view of their future
Why is delivering bad news difficult:
- Lack of training/experience
- Anxiety
- Burden of responsibility/inadequacy
- Fear of negative responses and strong emotional reactions
- Uncertainty about a patient's and family's expectations
- Fear of destroying a patient's sense of hope
Patient's regular desire to know about disease:
- 90% want to know about their illness
- 30% want to know the exact name of their illness
- 100% want to know about the chance of a cure
Barriers to delivering bad news in the clinic:
- Noise
- Inadequate time
- Distance between provider and patient
- Inadequate/overload of information
General techniques for improving the delivery of bad news:
- Use a caring voice
- Make eye contact
- Explain again, when necessary, use teach-back
- Use open-ended questions
- Be patient
The Six Steps of SPIKES:
- Set-up
- Perceptions
- Invitation
- Knowledge
- Emotions
- Strategy and summary

Culturally Congruent Communication

Culture: Groups' values, way of living, norms, customs, and beliefs
Cultural Identity: Each individual's values, traditions, beliefs, and expectations through a synthesis of their different groups, families, religious organizations, jobs, etc.
Cultural Safety: An approach that considers how social and historical contexts, as well as structural and interpersonal power imbalances, shape health care experiences
Cultural Awareness: An attitude that includes awareness about differences between cultures
Cultural Sensitivity: An attitude that recognizes the differences between cultures and that these differences are important to acknowledge in health care
Cultural Competency: An approach that focuses on practitioners' attaining skills, knowledge, and attitudes to work in more effective and respectful ways with indigenous patients and people of different cultures
Cultural Humility: An approach to health care based on humble acknowledgment of oneself as a learner when it comes to understanding a person's experience
Strategies for achieving culturally congruent communication:
- Critical self-awareness
- Personal commitment to understanding differences
- Exposure and learning
- Investment of time to negotiate meaning and ensure understanding
- Anticipation of difficulties
- Using an interpreter

Trauma Informed Care

Oral health as a cause of mental disorders:
- Neuroinflammation
- Poor nutrition
- Chronic physiological stresses
- Stigma
Mental health manifestations leading to dental issues:
- Anxiety
- Bipolar and OCD
- Depression
- Eating disorders
- Trauma
COVID/Mental Health/Oral Health survey results:
- 18% respondents rank mental health as poor
- Individuals with higher MH rating more likely to go to the dentist
- Those with poorer mental health status have higher rates of unmet oral health needs
- 47% of those with poor mental health said they were nervous for dental appointment
Trauma-informed care definition:
- Delivery of services grounded in an understanding and responsiveness to the impact of trauma, emphasizing physical, psychological, and emotional safety for everyone
Signs of individuals with past traumatic life events or adverse childhood experiences:
- Unfavorable general and oral health habits
- Display dental fear
- Avoid routine and preventative oral healthcare resulting in poorer oral health outcomes
Clinical symptoms of history of trauma:
- Endocrine changes
- Neglect of oral hygiene
- Gingival circulation
- Alteration in salivary flow

Managing Fear in Dental Care

Education is a key component in managing fear
Chairside Behavior management involves:
- Stimuli control
- Social praise
- Modeling
- Behavioral control
- Tell-show-do
Relaxation training techniques include:
- Diaphragmatic breathing
- Biofeedback
Other techniques used in managing fear include:
- Psychoeducation
- Motivational Interviewing
- Hypnosis
- Conative restructuring
- Exposure therapies (Graded exposure/Systematic desensitization)
- Pharmacological intervention

Mental Health Professionals

Psychiatrist: Diagnoses and treats mental illnesses, including pharmacological interventions
Psychologist: Diagnoses, assesses, and treats mental health issues, but does not provide pharmacological interventions
Licensed Clinical Social Worker: An MSW who works with patients in various ways
Mental Health Counselor: A Master's level clinician who works with patients to treat mental health issues under supervision

LGBTQ+ Lecture

Gender Definitions

Good definition: Emotional, psychological, and social traits that describe an individual as androgynous, masculine, or feminine
Bad definition: Strictly binary definition based on binary sex

Sex Definitions

Good definition: Assigned based on infant's chromosomes and genitalia
Bad definition: Based solely on genitalia at birth, disregarding intersex variations

Sexual Orientation Definitions

Good definition: Emotional, romantic, or sexual attraction to others, categorized as heterosexual, homosexual, bisexual, pansexual, asexual, or other identities
Bad definition: One's sexual attraction to either a woman or a man, categorized as heterosexual or homosexual

Nature of Gender and Sexual Orientation

Spectrum: Validating those who don't fit traditional norms

LGBTQ+ Health Data

Transgender people experience 2.5 times the violence as cisgender individuals
Bisexual people experience 7 times the victimization rate as heterosexual individuals and 3 times the rate of lesbian and gay individuals

Challenges Faced by Transgender Patients on Gender-Affirming Therapy

Physical Challenges

Masculine hormone therapy: Erythrocytosis, weight gain, acne, alopecia, sleep apnea
Feminizing therapy: CV disease, hepatic toxicity, weight gain, gallstones, dyslipidemia

Sociopsychological Challenges

Feminine therapy: Mood swings and emotional imbalance
Masculinizing therapy: Heightened and dampened emotions

Strategies for Inclusivity in Healthcare Settings

Training and education
Community engagement and partnerships
Inclusive language and communication
No assumptions
Ask questions
Admit limitations

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Description

Assess your knowledge of breaking bad news to patients in a clinical setting. This quiz covers the importance of patient communication, barriers to delivering bad news, and the Six steps of SPIKES.