abc's for breaking bad news following trauma
DESCRIPTION
Residents in General Surgery and Emergency Medicine Residencies are often faced with the task of breaking bad news with little or no formal training or guidance. While toolkits do exist for communicating bad news, there are none specific to trauma. We have developed a simple mnemonic in the ABCDE trauma style for breaking bad news in the acute trauma setting. Here are the citations for the work we used to help design this mnemonic: 1) Knops K, Lamba S. "Clinical Application of ASCEND: A pathway to Higher Ground for Communication." Journal of Palliative Medicine. 13.7 (2010): 825-830. 2) Baile WF, Buckman R, et al. SPIKES – A six-step protocol for delivering bad news: Application to the patient with cancer. The Oncologist, 2000; 5:302-11. 3) GP Dunn, R Martinsen, D Weissman. Surgical Palliative Care: A Resident’s Guide, 2009. American College of Surgeons. 179-202. This work has been funded by a grant from the Arnold P. Gold Foundation, formerly Picker Institute Graduate Medical Education Challenge Grant. This work represents only a small part of a larger curriculum being designed for teaching communication skills in the setting of trauma.TRANSCRIPT
Sarah Bryczkowski, MD; Sangeeta Lamba, MD; Anne Mosenthal, MD, FACS; Leslie Tyrie, MD
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ABC’S FOR BREAKING BAD NEWS
FOLLOWING TRAUMA
3.032
2
2.752.6
4.5
4
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
Total PGY1 PGY2 PGY3 PGY4 PGY5
Comfo
rtLeve
l
SurgeryResidentPostGraduateYear(PGY)
GeneralSurgeryResidentsComfortLevelforBreakingBadNewsinTrauma,byPostGraduateYear
1: Uncertain 3: Comfortable 5: Very Comfortable
n=8 n=8 n=5 n=6 n=4n=31
A: ANTICIPATE
• Who: Know the team – Nurse, treatment team,
consultants, palliative care/bereavement team, security
• What: Know the details – Results, known injuries,
consultant opinions (this may be incomplete)
• How: Mentally rehearse – Practice in your mind, pre-
meet and prepare the team if appropriate. Organize
events into cause and effect (i.e., blood pressure was
low, so we gave fluids/transfusion).
B: BE AWARE OF SELF AND SURROUNDINGS
• Appearance: Remove blood-splattered clothing. Wear a white coat
• Location: Find a quiet room. Silence your cell
phone/pager if possible
• Safety: Never go alone. Have a safe exit from the room
C: CONVERSATION/CONCERNS GATHER YOUR
TEAM AND START YOUR MEETING
• A: Acquaint yourself with family. ASK what they know.
• B: Begin with a warning - fire the warning shot
• C: Concise summary of events
• D: Do not speak - Allow silence, give space
• E: Empathy/Explain - Recognize emotions, answer
questions, provide next steps. Prepare the family to see
their loved one, or their loved ones body.
D: DOCUMENT, DEBRIEF AND DICTATE
• Document conversation in chart using the ABCDEs
from your conversation. Outline events
• Debrief with your team - Are they emotionally okay?
• Decide who will provide follow-up information to family
• Death - Call the medical examiner, call the sharing
network and dictate discharge summary.
E: ENDING THE ENCOUNTER
• Self-reflect on the encounter
• Think of ways for improvement
• Anticipate needs of the family in the next conversation
• Follow-up with clergy, palliative care team, or
bereavement support
IF YOU HAVE ANY QUESTIONS OR
SUGGESTIONS, PLEASE LET ME KNOW!
Sarah Bryczkowski, MD
Rutgers – New Jersey Medical School
This work was presented at:
Association for Surgical Education, 11 th Annual Thinking Out of the Box
Luncheon on April 10, 2014 in Chicago, IL during Surgical Education Week
Thank You!