BBM 2024.pdf

BREAKING BAD NEWS Introductory course 2024  Bad news is generally defined as any information that negatively impacts the life or vision of the DEFINITION future of those who receive it, according to their perspective.  RECENT STUDIES HA...

BREAKING BAD NEWS Introductory course 2024  Bad news is generally defined as any information that negatively impacts the life or vision of the DEFINITION future of those who receive it, according to their perspective.  RECENT STUDIES HAVE SHOWN THAT Patients generally (50-90%) Focused training in desire full & frank disclosure, communication skills & though a sizeable minority may techniques to facilitate not want the full disclosure. breaking of bad news has been (Ley p. Giving information to demonstrated to improve patients. New York: Wiley, 1982 patient satisfaction & physician ) comfort.  EXAMPLES OF CONDITIONS REQUIRING BREAKING OF BAD NEWS Cancer-related diagnoses Intra uterine foetal demise Life-long illness: Diabetes, Epilepsy Poor prognosis related to chronic diseases: loss of independence Informing parents about their child’s serious mental/physical handicap Giving diagnosis of serious sexually transmitted disease Nonclinical situations like giving feedback to poorly performing trainees or colleagues  WHO SHOULD BREAK BAD NEWS? The head of the unit or a senior consultant who is known to the patient and family members should deliver the bad news. A senior member of the nursing staff may need to be called to break the bad news in certain emergencies where the treating consultants may be absent. https://www.youtube.com/watch?v=9afuudUCKm4 https://www.youtube.com/watch?v=MKnWkrPLGOs https://www.youtube.com/watch?v=HWAZnhCuAeE SPIKES protocol or the modified version, P-SPIKES ABCDE protocol VARIOUS PROTOCOLS FOR BREAKING BAD NEWS Kaye’s 10-step model BREAKS protocol  Setting up the interview Arrange for some privacy Involve significant others as per the patient’s choice Sit down SPIKES Make connection with the patient: maintain eye contact and/or touch the patient (if he/she is comfortable with you doing so) Manage time constraints and interruptions  Assess the patient’s PERCEPTION Determine what the patient knows about the medical condition or what he (she) suspects SPIKES Listen to the patient’s level of comprehension Determine if the patient is engaging in illness denial  Obtain the patient’s INVITATION Ask the patient if he (she) wishes to know the details of the medical condition and/or treatment SPIKES Accept the patient’s right not to know Offer to answer questions later if he (she) wishes  Give KNOWLEDGE and information Warn the patient that bad news is coming; this may lessen the shock that can follow the disclosure of bad news Start at the patient’s level of comprehension and vocabulary SPIKES Use non-technical words Avoid excessive bluntness Give information in small chunks, and periodically check the patient’s understanding Avoid using phrases such as “There is nothing more we can do for you”  Address the patient’s EMOTIONS with EMPATHIC responses Observe for any emotion on the part of the patient Identify the emotion experienced by the patient SPIKES by naming it to oneself Identify the reason for the emotion Let the patient know you have connected the emotion with the reason for the emotion by making a connecting statement  STRATEGY and SUMMARY Summarize the information you have provided. If the patient is ready, discuss the treatment plan SPIKES Sharing responsibility for decision-making Check the patient’s understanding/misunderstanding of the discussion  ABCDE PROTOCOL  WHAT TO DO? Introduce yourself Look to comfort and privacy Determine what the patient already knows Warn the patient that bad news is coming Break the Bad News Identify the patient’s main concern Summarize and check understanding Offer realistic hope Arrange follow up and make sure that some one is with the patient when he leaves  HOW TO DO IT ? Be sensitive Be empathic and consider appropriate touching Maintain eye contact Give information in small chunks Repeat and clarify Regularly check understanding Do not be afraid of silence or tears Explore patient’s emotions and give him time to respond Be honest if you are unsure about something  WHAT NOT TO DO? Hurry Give all the information in one go Give too much information Use medical jargon or unclear language/words Lie or be economical with the truth Be blunt. Words can be like loaded pistols/guns Guess the prognosis (She has got 6 months, maybe 7)  DOCUMENTATION Documentation is very essential in breaking bad news—the detailed conversation, what was the information that was exchanged between the two parties, all these may be noted down properly. Detailed notes may be maintained in the patient’s files. The most important points to be kept in mind during documentation include the diagnosis, various options that were discussed regarding future management, and the exact words and expressions that were used while breaking the bad news. Maintaining accurate records will help in communicating with the treating team and facilitate proper follow-up care of the patient. Thank you!