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badnews.pptx
1. BREAKING BAD NEWS
A N E S S E N T I A L C O M M U N I C A T I O N S S K I L L
D R M O H A M A D A L - G A I L A N I
CO N SULTA N T SURGEO N
B R E A K I N G B A D N E W S C O U R S E
2 0 1 7
2. BAD NEWS
âąAny news that drastically and
negatively alters the patientâs view
of his or her future
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3. EXAMPLES OF BAD NEWS
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âąCancer diagnosis
âąIntra uterine foetal death
âąLife long illness e.g. Diabetes, epilepsy
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5. PATIENTS HAVE A RIGHT TO:
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âą Accurate and true information
âą Receive or not receive bad news!
âą Decide how much information they want or do not
want
âą Decide who should be present during the
consultation, e.g. Family members
âą Decide who should be informed about their diagnosis
and what information that person(s) should receive
6. RESPONSES TO BAD NEWS
âą Denial
âą Shock
âą Anger
âą Guilt
âą Blame
âą Agitation
âą Helplessness
âą Sense of unreality
âą Misinterpreting
information
âą Regret/anxiety
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7. DOâŠ
âą Ensure privacy and
confidentiality
âą Respect
âą Honest
âą Simple language
âą Listen
âą Sensitive to the non-
verbal language
âą Allow for silence, tears
and other patient
reactions
âą Document and liaise
with the
multidisciplinary team
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8. DO NOTâŠ
âąOverload with
information
âąDistort the truth
âąGive false
reassurance
âąFeel obliged to keep
talking all the time
âąWithhold information
âąAssume that you
know what is
concerning the
patient
âąCriticize
âąMake judgements
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9. AVOID
1. Meeting in public
2. Being alone
3. Hurrying!
4. Not being prepared!
5. Interrupted by your mobile phone!
6. Patronizing e.g. It is all your fault you smoked!
7. Give prognosis e.g. You have 6 months to live!
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11. 1. S: SETTING
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ïŒArrange for some privacy
ïŒSit down
ïŒMake connection and establish rapport with
the patient
ïŒManage time constraints and interruptions
12. 2. P: PERCEPTION
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ïŒDetermine what the patient knows?
ïŒListen to the patient!
ïŒAccept denial but do not confront at this
stage.
13. 3. I: INVITATION
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ïŒAsk patient if they wish to know?
ïŒAccept patientâs right not to know!
ïŒOffer to answer questions later if they wish
14. 4. K: KNOWLEDGE
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ïŒUse language appropriate to patient
ïŒGive information in small chunks
ïŒGive diagnosis e.g. Cancer
ïŒGive any positive aspects e.g. Cancer has not
spread
ïŒCheck whether the patient understood what
you said!
15. 5. E: EXPLORE
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ïŒPrepare to give an empathetic response
ïŒGive the patient time to express their
feelings then respond
16. 6. S: STRATEGY (SUMMARY)
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ïŒAsk whether they want to clarify
something else?
ïŒOffer agenda for the next meeting e.g. I
will speak to you again when we have the
opinion of cancer specialist.
ïŒClose the interview
17. V I D E O
H O W N O T T O
B R E A K B A D N E W S
B R E A K I N G B A D N E W S C O U R S E 3 R D F E B R U A R Y
2 0 1 7 D R . M O H A M A D A L - G A I L A N I
18. HOW NOT TO
BREAK BAD NEWS
Scenario: Relative informed (in public) by a junior doctor of the
passing away of his father admitted to ER with a heart attack!
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19. VIDEO SCENARIO
âąWhat went Wrong in this scenario?
1.Conducted in Public
2.Not given by the appropriate person
3.No Privacy
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20. S C E N A R I O
NEW
BREAST CANCER
DIAGNOSIS
( T h e c a s e o f M r s . A m a l )
DR. MOHAMAD AL-
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21. SCENARIO: (The case of Mrs. Amal)
âą10 minutes (Scenario): The Consultation
between Mrs. Amal and her surgeon Dr.
âąLee.
10 minutes: Observer remarks.
âą10 minutes: Course Participantsâ remarks
âąGeneral Discussion & Questions.
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22. SCENARIO: (The case of Mrs. Amal)
âą Mrs. Amal is a 38-year-old housewife who presented
with a 3-week history of feeling a lump in her right
breast.
âą She has last week seen her surgeon Dr. Lee who after
examining her ordered investigations.
âą The investigations included a mammogram,
ultrasound and a needle core biopsy from the lump
her right breast.
âą She has come today for the Results of her
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23. SCENARIO:
1. S: âGood afternoon Mrs. Amalâ
2. P: âWhat do you know so far Mrs. Amalâ?
3. I: âWould you like me to discuss your resultsâ?
4. K: âIâm afraid Ihave some bad news for youâ, K âThe test
results regrettably confirmed my fearsâŠof breast cancerâ
5. E: Checks the patient has understood the bad news E Let
patient ask questions and to discuss their concerns E Gives
room to the patientâs feelings and silence.
6. S: âCan Isummarize what we have discussedâ, S âIwill
arrange for us to meet again next weekâ, S âGoodbye Mrs.
Amal, see you next Monday with your husbandâ
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24. OBSERVER COMMENTS:
Interruptions.
CASE OF MRS. AMAL
âą What went well? Privacy, Eye Contact, No
âą Was it according to âSPIKESâ? Yes
âą Did Dr. Lee show Empathy, Knowledge,
Summate? Yes
âą What could have been done better? Presence of
a Chaperon (Nurse), More Listening, Time for
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25. BREAKING BAD NEWS
SUMMARY
âąA Difficult But Fundamentally Important Task
for All Health Care Professionals.
âąFocused Training in Communication Skills &
Techniques Improves Performance.
âąEnhances Patientsâ Satisfaction & Physiciansâ
Comfort.
âąAn Essential Skill of Good Medical Practice.
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