2. A close friend of your family,
Mrs. S., aged 38 years
was investigated recently.
Report confirms diagnosis of breast cancer.
How will you convey this diagnosis?
4. ⢠A situation where there is no feeling of hope
⢠Threat to a personâs mental or physical
well-being
⢠A risk of upsetting an established life style
⢠A message which conveys to a person that
choices in his/her life may be reduced
What is bad news?
?
6. ⢠Cannot cope with life!
⢠âShe will never be able to bear itâ
⢠âHe will commit suicideâ
Shows âProtectiveâ nature of family
Why does the family ask us not to tell
their loved one?
7. Importance of Telling the truth
ď People have the Right to know
ď Permits patients, families to plan, cope
ď Reduces uncertainty. Avoids false hope
ď Builds physician-patient trust
ď Co-operate with treatment
But how do we know who can take it and who cannot?!
8. To tell or not to tell
is not the question
How to tell is important
(If the patient wants to know)
9. âI donât know what to sayâ Dr. Robert Buckman
Learning Communication skills
bridges the communication gap,
makes the âpainâ easy to bear.
10. 1. Setting the scene - Getting started
2. Patientâs Perception - What does the patient know?
3. Inviting patient - How much does he want to know?
4. Knowledge of his disease - Sharing the information.
5. Emotions - Responding to patientâs / familyâs feelings
6. Summarising - Planning and follow-up
Adapted from Robert Buckman
S P I K E S 6 â Step Protocol
11. The Technique of Breaking Bad News
Communication techniques are like basic manners!
Use the skills in all your interviews!
1. Seating and Greeting â Introduction, addressing by
name, basic courtesies and politeness
2. Eyes Same level â sitting down, No barrier
3. Relaxed posture
4. Lean forward , show that you are LISTENING
12. Step 1: Setting the scene â Getting started
⢠Plan what you will say
- Confirm medical facts, Confirmed diagnosis
- Anticipate questions. Be prepared to respond.
- Knowledge of prognosis
⢠Maintain a Private environment
13. Step 2: Patientâs Perception â
What does the patient know?
Find out what the patient knows:
With Open Questions:
âWhat do you know about your illness?â
âWhat did your doctor tell you ?â
ListenâŚâŚ.
14. Step 3: Inviting patient â
How much does the patient want to know?
Appropriate questions:
âDo you want to know more about your disease?â
Patient may say: âIts enough if you can relieve my pain,
I do not wish to knowâ
Do not thrust information!
Finish the interview with appropriate hope
15. Step 3: How much does the patient
want to know?
Doctor: âWould you like me to tell you more
about your disease ?â
Patient : âYes, I want to know, please tell meâ
16. Step 4: Knowledge of his disease
Sharing the Information (bad news)
ď A. Give a âwarning shotâ Pause..
ď B. Say the news (diagnosis) Pause..
A. Warning shot â examples :
âIt looks like what you have is not the usual (or âordinaryâ)
kind of âswellingâ (or âwoundâ)â
âWhat you have is something that may be difficult to cureâ
or, ânot possible to operate onâ
17. Step 4: Sharing the information - two stages
Having given the Warning Shot,
B. Say the diagnosis, then stop, Pause..
⢠avoid medical terms, pause frequently
⢠check for understanding
⢠use silence, body language
⢠avoid monologue, promote dialogue
18. Step 5: Emotions - Responding to feelings
Give time to react
â˘Listen quietly, attentively, allow ventilation of feelings
â˘Use nonverbal communication
â˘Encourage descriptions of feelings â Example:
âWhat are your feelings after what Iâve just told you?â
Listen, Acknowledge feelings â âI see you are very upsetâ
Or, âI can quite understand your anger..â
19. Step 6: Summarising - Planning, follow-up
⢠Explain Plan for the next steps, as needed:
- Any additional information, tests needed
- Treat symptoms, referrals as needed
⢠Discuss potential sources of support
⢠Reassure availability and Continuity of Care
⢠Always give Realistic hope
20. Communication is like a Prescription!
ď§ The Right drug (information)
ď§ For the Right reason - (according to patientâs emotions)
ď§ At the Right time (when patient is ready for it)
ď§ Given in the Right Dose (in bits - on a need to know basis)
21. Communicating Bad News â
How can we reduce the unpleasant experience?
⢠Preparation and gentle honesty
⢠Use clear language, pause now and then
⢠Do not thrust unasked information !
⢠Give time to âsink inâ the information
⢠Give appropriate hope, availability of treatment
⢠Offer continuity of care
22. â To Patient or Care giver
⢠Progress of disease / Cancer metastasis
⢠When patient is in advanced stage
⢠In a terminal condition or at end-of-life
Other Clinical Situations where
âBad newsâ may have to be conveyed:
23. Communicate Effectively byâŚ..
⢠Asking before telling
⢠Pausing
⢠Taking the cue from the patient
⢠Acknowledging after their Emotion
⢠Responding: Open question / Empathic response
25. Importance of attempting to break the Bad News -
ď˝ Patient has a right to know
ď˝ Not telling may do more harm than good
ď˝ Do not tell if he does not want to know
ď˝ To tell or not to tell is not the issue
HOW to tell is important !