Term
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Definition
• 6 step protocol in delivering bad news
• Published by Robert Buckman
• News never delivered to patient in the past
• In Europe, news is delivered to the family
member
• From 1950-1970, telling the patient they
had cancer, and treatment was bleak, the
studies showed physicians felt it was
inhumane to tell |
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Term
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Definition
• Think of your rotations or someone who
has changed your view on how you look at
something/whether you enjoyed it more/or
less and why?
• How did it make you feel?
• How do you not destroy hope?
• How do you deal with emotions? |
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Term
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Definition
• What is it?
• Any information which adversely affects an
individual’s view of his or her future
• Bad news is in the “eye of the beholder”
• Stressful
• Shocking
• By the 1970’s – ethical to tell patients of
their prognosis |
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Term
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Definition
• You use steps for treating DKA
• You use steps for CPR
• Steps may be used for delivering bad
news too |
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Term
| Goals for delivering bad news |
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Definition
• Gather info from the patient-allows you to
determine the patient’s knowledge and
expectations and readiness to hear the bad news
• Provide intelligible info in accordance with the
patient’s needs and desires
• Support the patient by employing skills to reduce
the emotional impact and isolation experienced by
the recipient of bad news
• Develop a strategy in the form of a treatment plan
with the input and cooperation of the patient |
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Term
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Definition
• Rehearsal
• Privacy
• Undistracted focus, no instagram, pagers, cell phones
• Arrange for privacy
• Have tissues
• Involve significant others
• Sit down
• Make a connection with the patient=eye contact,
touching
• Manage time constraints and interruptions |
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Term
| Step 2: Assessing the Patient’s Perception |
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Definition
• Before you tell, ask….
• What have you been told about your medical
situation?
• Do you understand why we did a CT scan?
• This establishes if the patient is in any form of
denial |
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Term
| Step 3: Obtaining the Patient’s Invitation |
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Definition
• Some patients do not want to know their
diagnosis
• Shunning info is a natural coping mechanism
• Plan for a time when the patient can meet
again or can see their next provider
• “How would you like me to give you the
information” |
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Term
| Step 4: Giving Knowledge and Info to the Patient |
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Definition
• Warning the Patient that bad news is coming
• “Unfortunately I’ve got bad news or I’m sorry to tell
you”
• Nontechnical words
• Avoid bluntness
• Give info in small chunks
• Check to see if patient is understanding
• Avoid saying “there is nothing more we can do for
you”
• Focus on therapeutic/positives like good pain
control and symptom relief |
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Term
| Step 5: Addressing the Patient’s Emotions |
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Definition
• Empathic responses
• Patient’s may respond with disbelief, anger,
crying, or denial
• May feel expression of shock, isolation and
grief |
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Term
Step 5: Empathic Response
• Four Steps |
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Definition
– Observe any emotion on the patient
– Identify the emotion by naming it to oneself
• I.e.: use open questions to query the patient as to what they
are feeling or thinking
– Identify the reason for the emotion-usually connected to
the bad news
– Let the patient know you’ve connected the emotion with
the reason for the emotion
• I.e.: PA: I’m sorry that the x-ray shows that chemotherapy isn’t
working. Unfortunately, the tumor has grown somewhat
• Patient: I’ve been afraid of this
• PA: (moves chair closer, offers patient a tissue/pauses) I know
that this isn’t what you wanted to hear. I wish the news were
better. |
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Term
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Definition
• Until an emotion is cleared it will be difficult
to move on to discuss other issues.
• May use empathic responses until patient
becomes calm
• May use empathic responses to
acknowledge your own sadness
• Ask exploratory questions
• Validating responses |
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Term
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Definition
• I can see how upsetting this is to you
• I can tell you weren’t expecting to hear this
• I know this is not good news for you
• I’m sorry to have to tell you this
• This is very difficult for me also
• I was hoping for a better result |
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Term
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Definition
• How do you mean?
• Tell me more about it
• Could you explain what you mean?
• You said it frightened you?
• Could you tell me what you are worried
about?
• Now you said you were concerned about
your children, tell me more… |
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Term
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Definition
• I can understand how you felt that way
• I guess anyone might have that same reaction
• You were perfectly correct to think that way
• Yes, your understanding of the reason for the
test is very good
• It appears that you have thought things
through very well
• Many other patients have had a similar
experience |
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Term
| Step 6: Strategy and Summary |
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Definition
• Make sure patient is ready for this
• Explore the patient’s knowledge,
expectations and hopes, fears,
misconceptions
• Discuss symptom control
• Plans for the next step
• Best possible treatment
• Continuity of care |
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Term
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Definition
• Advance prep
• Build a therapeutic
environment/relationship
• Communicate well
• Deal with patient and family reactions
• Encourage and Validate emotions |
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Term
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Definition
• Using layman’s terms
• Making eye contact
• Professionalism
• Compassion/empathy
• Attitude
• Maturity
• Inviting patient to ask questions/correct
misconceptions
• Providing patient with follow-up plans |
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