communicating bad news to patients and patients’ families · 13-nov-17 5 strategies for breaking...
TRANSCRIPT
13-Nov-17
1
Breaking Bad News to Patients and Patients’
Relatives
Professor A. Ojebode
Department of Communication and Language Arts
University of Ibadan
April, 2017.
What is Bad News? O What is bad news?
O What names/terms do we use to refer to bad news?*
O Any information which adversely and seriously affects an
individual’s view of his or her future (Buckman, 1992)
O Future – it is not what happened. It is “what will now
happen”
O In our context, it is also about the future of the others
around the patient – children, wife, mother
O Who determines how bad the news is?
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Don’t assume you know how bad the news is or what makes it bad
Star Actress Kenya Moore grieves over
the loss of her pet (dailymail.co.uk)
13-Nov-17
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Why Learn to Break Bad News -1
O Breaking bad news is something you will
always have to do; there is no running away
from it*.
O It is not a pleasant experience for both the
news bearer and the patient. It is worse if
O The medical person is inexperienced.
O It the patient is young
O If the prospect of active treatment is limited.
Why Learn to Break Bad News - 2 O Most patients want to know the truth. A 1992
survey shows
O 96% of Americans wanted to be told if they had
cancer
O 85% wished to know how long they’d realistically
live in cases of grave prognosis (Baile et al 2010)
O It is ethically and legally mandatory to inform
patients of their state/status
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Why Learn to Break Bad News - 3
OHow bad news is presented has clinical
outcomes. It can affect:
O Level of hopefulness
O Comprehension of information
O satisfaction with medical care
O Subsequent psychological adjustment
(Baile et al, 2010)
Why Breaking Bad News is Difficult
O Little or no formal training
O Caregiver’s own schedule and workload –
BBN requires time
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Strategies for Breaking Bad News O Buckman’s Six-Step Protocol
O Baile et al’s SPIKES, etc
O Generally, BBN requires an “interview session”.
The session should succeed at:
O Eliciting information from the bad news receiver-to-
be
O Giving medical information – what has happened
O Providing support
O Eliciting cooperation for ‘next steps’
Baile et al’s SPIKES
OS= Setting up the interview
OP= Assessing Patient’s Perception
O I= Obtaining Patient’s Invitation
OK= Give Knowledge and Information
OE= Addressing Patient’s Emotions with
Empathic Response
OS= Strategy and Summary
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O Non-verbal communication – especially eye
contact, permissible touch;
O Low friendly, reassuring tone
O Empathic statements – this makes me too
sad; I was really hoping for a better result
O Never blame/moralise, no reference to
lifestyle
O Kind, not sarcastic, euphemisms
On Kind Euphemisms … O Euphemisms are rooted in culture. What are the less
painful, that is, euphemistic ways of saying:
1. You will soon be blind.
2. You have 3 months to live
3. The chemo didn’t work and the tumour has increased.
4. Your wife got a stillbirth again.
5. Your daughter is pregnant.
O There is a danger in using euphemism … “aberrant
decoding”
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Pain respects no one
http//:
O Heart (Empathy)
O Time (For rapport, healing)
O Tactics (clear, soft, culture-sensitive
communication)
O Place (privacy, proxemics)