Effective PatientCommunication                      Module 2: Sharing Bad News     Module development supported by a grant...
Learning Objectives Define bad news Demonstrate use of the SPIKES model when  sharing bad news with the patient During ...
Expected Outcomes Recognize challenges and supports to effectively  sharing bad news with the patient & family Demonstra...
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, th...
What is Bad News?Information that negatively alters the patient’s view of the future (Buckman, 1992)     (Tissot, 1872)   ...
Challenges                    Lack of:                      Guidelines                      Training                   ...
Supporting Patient & Provider Patient & Family are supported by:   Being included in conversations & planning   Being t...
SPIKES Model: The Six Steps Setting Perception Invitation Knowledge Emotions Strategy & Summary   Baile WF, Buckman ...
Setting the Environment Provide privacy Introduce self Determine who else should be present Ensure no interruptions P...
Perception Prepare before  speaking Ask about patient’s  perception of what is  going on                          (Renoi...
Invitation                    Ask questions to invite                     the patient into                     conversati...
Knowledge Deliver the message   Use plain language   Be mindful of body language   Get to the point   Give informatio...
Emotions and Empathy Be prepared for patient’s and family’s emotional  response Anticipate fear, anger, sadness, denial,...
Strategy and Summary Assess patient’s readiness for planning   Negotiate next steps   Verify support structure   Ackno...
Video©2009 –“Sharing Bad News” Henry Ford Health System Department of Medical Education Video clip used with permission.  ...
Discussion of the Video How well did the doctor handle the situation?   What worked well?   What could have been handle...
What’s Next?                 Expectations                 Reminders(Mahmud, 2008)                                 18
Special ThanksModule Development supported by a grant from thePicker Institute/ Gold Foundation 2010 Challenge Grant©2009 ...
ReferencesAmerican Academy on Communication in Healthcare (AACH). Enhancing Communication Skills.   http://www.aachonline....
File: James Tissot-Bad News.jpg. National Museum Cardiff; 1872. Wikimedia Commons.      http://commons.wikimedia.org/wiki/...
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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

  1. 1. Effective PatientCommunication Module 2: Sharing Bad News Module development supported by a grant from the Picker Institute / Gold Foundation 2010 Challenge Grant
  2. 2. 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
  3. 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
  4. 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
  5. 5. What is Bad News?Information that negatively alters the patient’s view of the future (Buckman, 1992) (Tissot, 1872) 6
  6. 6. Challenges  Lack of:  Guidelines  Training  Experience  Good role models  Concerns of:  The provider(Siegmund, 2008)  The patient & family 7
  7. 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
  8. 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
  9. 9. Setting the Environment Provide privacy Introduce self Determine who else should be present Ensure no interruptions Provide comfortable space Create welcoming environment 10
  10. 10. Perception Prepare before speaking Ask about patient’s perception of what is going on (Renoir/ Bjoertvedt, 2010) 11
  11. 11. Invitation  Ask questions to invite the patient into conversation  Ask how much information the patient wants to hear(Pissarro, 1881) 12
  12. 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
  13. 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
  14. 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
  15. 15. Video©2009 –“Sharing Bad News” Henry Ford Health System Department of Medical Education Video clip used with permission. 16
  16. 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
  17. 17. What’s Next? Expectations Reminders(Mahmud, 2008) 18
  18. 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
  19. 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
  20. 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

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