Breaking Bad News Presentation PPT PDF

Breaking Bad News Thursday, January 9, 2025 1  Objectives By the end of this session, you will be able to Realize the importance of breaking bad news in family practice. Learn the different approach of Breaking Bad News. Recognize the challen...

Breaking Bad News Thursday, January 9, 2025 1  Objectives By the end of this session, you will be able to Realize the importance of breaking bad news in family practice. Learn the different approach of Breaking Bad News. Recognize the challenge of sharing bad news effectively. Be committed to improving your skills in breaking bad news to patients. Thursday, January 9, 202 5  Some situations are predictably associated with poor recall. These include:  Discussion of many medical problems at one visit,  Patient anxiety,  Prescription of more than one medication, and  Relaying of new or bad news. Thursday, January 9, 2 025  What is bad news ‘...any information which adversely and seriously affects an individual’s view of his or her future’. Buckman, 1992 Buckman R. Breaking Bad News: A Guide for Health Care Professionals. Baltimore: Johns Hopkins University Press, 1992:15 Thursday, January 9, 202 5  Why is Breaking Bad News is Difficult? 1. Uncertainty of how to deal with an intense emotional reaction. 2. Effect on the patient (hope). 3. The need to individualize the manner of breaking bad news. 4. Unpleasant task. 5. Patient / Family reaction. Thursday, January 9, 202 5  Why is it important to be good at breaking “Bad News”? We do it often When we do it poorly, it’s a disaster We often do it poorly – We’re not taught, – We have few protocols. – When we do it well, it’s uncomfortable and distressing. It hurts us too. Thursday, January 9, 202 5 Stress experienced by physician and patient in the discussion of bad news. Thursday, January 9, 202 Ptacek JT, Eberhardt TL. Breaking bad news: a 5 review of the literature. JAMA 1996;276:496-502  Breaking Bad News Thursday, January 9, 202 5  Factors Modifying the Perception of any News Patient Factors – Background (religion, support, knowledge, … etc) – Demographic Data (age, job, … etc) – Psychosocial issues Disease Factors – Nature of Symptoms – Diagnosis – Treatment Options (tab vs injection) – Prognosis Thursday, January 9, 202 5  What do patients want? For themselves… more time to talk and show feelings From the doctor… more information, caring, hopefulness, confidence a familiar face Strauss 1995 Thursday, January 9, 2 025  Possible Reaction to Bad News Possible shock Stress Anger Grief Guilt Denial Depression Fear Loss of self esteem Sense of loss Suicide Anxiety Thursday, January 9, 202 5  COMMUNICATING BAD NEWS WELL TO PATIENTS IS NOT AN OPTIONAL SKILL; IT IS AN ESSENTIAL PART OF PROFESSIONAL PRACTICE Thursday, January 9, 202 5  Breaking Bad News You have also metastasis in your lung, liver and bone … ng L u ce n Ca r Thursday, January 9, 202 5  Methods of delivering bad news ABCDE SPIKES Thursday, January 9, 202 5  Approach for Breaking Bad News ABCDE A: Advanced Preparation B: Building a Therapeutic Relationship and Environment C: Communicate Well D: Dealing with the Patient and Family Reaction E: Encouraging / Validating Emotions Thursday, January 9, 202 5  Advanced Preparation Familiarize yourself with the patient data, patient background and relevant clinical data. Prepare phrases and words to use or avoid. Be prepared to provide basic information about prognosis and treatment options. Prepare yourself emotionally. Write agenda. Thursday, January 9, 202 5  Building a Therapeutic Environment / Relationship ENVIRONMENT: Adequate time No interruptions Privacy (outpatient VS inpatient) Comfortable location. Turn your pager/cell phone to silent mode or leave it with a colleague. Thursday, January 9, 202 5  Building a Therapeutic Environment / Relationship RELATIONSHIP: Introduce yourself Ask for names and relationships Identify patient’s preferences regarding the disclosure (what / how much) Have family members or other supportive persons present Use touch where appropriate, be sensitive to cultural and personal preference. Assure the patient you will be available Thursday, January 9, 202 5  Communicate Well  How much the patient knows about his condition  Ask about his understanding of the investigations  START WITH “Sorry, I have bad news.”  Explain the condition (frankly BUT compassionately)  Allow silence and tears, avoid the urge to talk to overcome your own discomfort.  Encourage questions  Check understanding. Thursday, January 9, 202 5  Communicate Well  Ask open-ended questions  Proceed slowly, with low tone  decrease anxiety  ICE-Impact  Use the patient’s own words.  Avoid medical terminology.  Consider psychosocial issues. Thursday, January 9, 202 5  Communicate Well LISTEN, LISTEN, and LISTEN Use repetition and give a summary Arrange than one session Always acceptable to say “I don’t know, but I will try to find out.” At the conclusion of each visit, summarize and make follow-up plans. Thursday, January 9, 202 5  Dealing with the Patient and Family Reaction  Assess the emotional reaction (follow-up)  Empathize the emotional reaction – If the patient cries, offer a tissue  Allow time to express emotions  Encourage to remember previous bad experiences and how to deal with them  Don’t argue or criticize colleagues  Don’t defend yourself, colleagues, or medical care Thursday, January 9, 202 5  RESPOND TO EMOTIONS  Tears, anger, anxiety are normal reactions  Cognitively, patients may express denial, blame, guilt, fear, shame.  Rarely, one may experience a panic attack  Let the emotion express itself, acknowledge it, be attentive  Silence, touch, comfort  Assess safety, need for support Thursday, January 9, 202 5  Encourage / Validate Emotions  Offer realistic hope.  Inquire about the patient's motional and spiritual needs  Discuss treatment options.  Every effort will be made to relieve symptoms  Use interdisciplinary services to enhance patient care  Plan for follow up or referral  Decision about future Thursday, January 9, 202 5  ‫حسنًا يا صالح ‪.‬طريقتك ال بأس بها ولكن‬ ‫‪ Empathy.‬تحتاج ألن تتصرف بشكل أكثر‬ ‫من يحب منكم أن يجرب مرة ثانية‬ ‫‪B‬‬ ‫?‪Breaking bad news‬‬ ‫‪Thursday, January 9, 202‬‬ ‫‪5‬‬ Approach for Breaking Bad News S etting up the interview P erception of the patient’s illness I nvitation from patient to share information Knowledge and Information conveyed E motions responded to empathically S ummary and Strategy for follow-up Thursday, January 9, 202 5 S – Setting up the interview  Privacy  Involve others  Listening mode  Availability Thursday, January 9, 2025 P - Perception  Ask before you tell  Find out what the patient knows  ICE Thursday, January 9, 2025 I – 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  How much information would the patient like to know Thursday, January 9, 2025 K – Knowledge  Warning first  Avoid jargon  Small chunks  Use of silence  Allow time for emotions Thursday, January 9, 2025 E – Emotions  Recognise  Listen for and identify the emotion  Identify the cause of the emotion  Show the patient you have identified both the emotion and its origin Thursday, January 9, 2025 S – Strategy and Summary  Understanding reduces fear  Summarise the discussion  Strategy for future care  Schedule next meeting  Allow time for questions  Leaflets Thursday, January 9, 2025  Breaking Bad News - Summary Acknowledge it’s a difficult task for physician and patient. Utilize ABCDE and “SPIKES” Address support family, friends, medical - - set up next visit Identify potential cultural differences Thursday, January 9, 202 5  Some Important Skills in breaking bad news Keeping eye contact Showing empathy Lessening and no interruptions Continuous feed back Support & accessibility Thursday, January 9, 202 5  “If breaking bad news is done well our patients and their relatives will never forget us. If done badly they may never forgive us”. Buckman (1996) Thursday, January 9, 202 5 Knowing the Disease is NOT as Important as Knowing the Person who Has the Disease Thursday, January 9, 202 5  Role Play  Rapport  Settings “Do you need any one with you, No interruptions, close your phone, sit close to the patient, identify ”.  Perception “What you know about your situation?”  Invitation “What you need to know about your situation?” Thursday, January 9, 2025  Knowledge “In stages tell him about the diagnosis and nature of the disease”  PAUSE  Emotions.  Can you procede?  Treatment “Referral to specialist”.  Close of the session (summary, feedback, any question, thanks). Thursday, January 9, 2025  Com Quest ment ions? s! Thursday, January 9, 202 5  Thanks Thursday, January 9, 202 5