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Integrating Patient- and Family-Centered Care Principles into a Simulation-Based Curriculum: Dartmouth-Hitchcock Medical Center
 

Integrating Patient- and Family-Centered Care Principles into a Simulation-Based Curriculum: Dartmouth-Hitchcock Medical Center

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    Integrating Patient- and Family-Centered Care Principles into a Simulation-Based Curriculum: Dartmouth-Hitchcock Medical Center Integrating Patient- and Family-Centered Care Principles into a Simulation-Based Curriculum: Dartmouth-Hitchcock Medical Center Presentation Transcript

    • Effective PatientCommunication Module 2: Sharing Bad News Module development supported by a grant from the Picker Institute / Gold Foundation 2010 Challenge Grant
    • Learning Objectives Define bad news Demonstrate use of the SPIKES model when sharing bad news with the patient During the patient encounter, attend to the major emotional components of sharing bad news, especially expressions of fear, anger, sadness, denial, and guilt 3
    • Expected Outcomes Recognize challenges and supports to effectively sharing bad news with the patient & family Demonstrate the SPIKES model communication strategy when sharing bad news with the patient & family Demonstrate empathy when sharing bad news with the patient 4
    • The Task of Breaking Bad News“If we do it badly, the patients or family members may never forgive us; if we do it well, they may never forget us.”(Buckman, 1992) 5
    • What is Bad News?Information that negatively alters the patient’s view of the future (Buckman, 1992) (Tissot, 1872) 6
    • Challenges  Lack of:  Guidelines  Training  Experience  Good role models  Concerns of:  The provider(Siegmund, 2008)  The patient & family 7
    • Supporting Patient & Provider Patient & Family are supported by:  Being included in conversations & planning  Being treated as care partners Provider is supported by:  Training & Practicing good communication skills  Learning ways to effectively cope with emotionally charged issues  Having another person available who knows the patient 8
    • SPIKES Model: The Six Steps Setting Perception Invitation Knowledge Emotions Strategy & Summary Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. SPIKES-A Six-Step Protocol for Delivering Bad News: Application to the Patient with Cancer. The Oncologist, 5, 302-311; 2000. SPIKES mnemonic used with permission. 9
    • Setting the Environment Provide privacy Introduce self Determine who else should be present Ensure no interruptions Provide comfortable space Create welcoming environment 10
    • Perception Prepare before speaking Ask about patient’s perception of what is going on (Renoir/ Bjoertvedt, 2010) 11
    • Invitation  Ask questions to invite the patient into conversation  Ask how much information the patient wants to hear(Pissarro, 1881) 12
    • Knowledge Deliver the message  Use plain language  Be mindful of body language  Get to the point  Give information in small chunks  Pause  Wait for reaction Use “teach back” to verify that message was received 13
    • Emotions and Empathy Be prepared for patient’s and family’s emotional response Anticipate fear, anger, sadness, denial, guilt Be mindful of your own response Comfort the patient 14
    • Strategy and Summary Assess patient’s readiness for planning  Negotiate next steps  Verify support structure  Acknowledge & answer questions Summarize plan  Use “teach back” technique  Follow-up 15
    • Video©2009 –“Sharing Bad News” Henry Ford Health System Department of Medical Education Video clip used with permission. 16
    • Discussion of the Video How well did the doctor handle the situation?  What worked well?  What could have been handled better? Have you experienced a scene like the one shown?  What was your role?  Describe the encounter 17
    • What’s Next? Expectations Reminders(Mahmud, 2008) 18
    • Special ThanksModule Development supported by a grant from thePicker Institute/ Gold Foundation 2010 Challenge Grant©2009 –“Sharing Bad News” Henry Ford Health SystemDepartment of Medical EducationThe DHMC Patient and Family Centered Care Department,and Chaplaincy 19
    • ReferencesAmerican Academy on Communication in Healthcare (AACH). Enhancing Communication Skills. http://www.aachonline.org/?page=EnhanceCommSkills. Accessed October 20, 2010.Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. SPIKES-A Six-Step Protocol for Delivering Bad News: Application to the Patient with Cancer. The Oncologist, 5, 302-311; 2000.Bjoertvedt. File: Auguste Renoir Conversation.JPG. National Museum Stockholm; 2008. Wikimedia Commons. http://commons.wikimedia.org/wiki/File:Auguste_Renoir_Conversation.JPG. Accessed December 6, 2010.Boyle WE, Colacchio TA. Patient and Family Centered Care at Dartmouth-Hitchcock. [DVD]. Lebanon, NH: Dartmouth- Hitchcock Media Services; 2010.Bub B. Communication Skills That Heal. United Kingdom: Radcliffe Publishing Ltd; 2006.Buckman R. How to Break Bad News: A Guide for Health Care Professionals. Baltimore, MD: The Johns Hopkins University Press; 1992.Buckman R. Talking to Patients About Cancer. BMJ, 313, 699-700; 1996.Coulehan JH, Block MR. The Medical Interview, Mastering Skills for Clinical Practice. 5th ed. Philadelphia, PA: F.A. Davis Company; 2006. 20
    • File: James Tissot-Bad News.jpg. National Museum Cardiff; 1872. Wikimedia Commons. http://commons.wikimedia.org/wiki/File:James_Tissot_-_Bad_News.jpg. Accessed December 6, 2010.File:Pissarro Conversation.jpg. Tokyo: The National Museum of Western Art; 1881. Wikimedia Commons http://commons.wikimedia.org/wiki/File:Pissarro_Conversation.jpg.. Accessed December 6, 2010.Frampton S, Guastello S, Brady C, Hale M, Horowitz S, Smith SB, Stone S. Patient-Centered Care Improvement Guide. Picker Institute; 2008. http://pickerinstitute.org/wp-content/uploads/2010/06/pcc_improvement_guide.pdf. Accessed October 29, 2010.Henry Ford Health System Department of Medical Education. Sharing Bad News. [DVD]. Detroit, MI: Henry Ford Health System; 2009.Lloyd M, Bor R. Communication Skills for Medicine. 3rd ed. London: Elsevier; 2009.Mahmud A. File: Serious Discussion image by Ashfaq.JPG. Dhaka University Institute of Fine Arts; 2008. Wikimedia Commons. http://commons.wikimedia.org/wiki/File:Serious_Discussion_image_by_Ashfaq.JPG. Accessed December 6, 2010.Rider EA, Nawotniak RH, Smith G. A Practical Guide to Teaching and Assessing the ACGME Core Competencies. Marblehead, MA: HCPro, Inc; 2007.Siegmund W. File: Mount Rainier 5839.JPG. 2008. Wikimedia Commons. http://commons.wikimedia.org/wiki/File:Mount_Rainier_5839.JPG. Accessed December 6, 2010.Weiss BD. (2007). Removing Barriers to Better, Safer Care, Health Literacy and Patient Safety: Help Patients Understand, Manual for Clinicians. 2nd ed. American Medical Association Foundation and American Medical Association. http://www.ama-assn.org/ama1/pub/upload/mm/367/healthlitclinicians.pdf. Accessed December 15, 2009. 21