Patient support workshop presentation

www.hfea.gov.uk
Patient Support Skills
Workshop
Welcome

Overview of the day
10.30 - 10.55 Introduction
10.55 - 11.40 Session 1: How to write your patient support policy
How to demonstrate compliance at inspection
11.40 - 12.55 Session 2: Customer service skills
12.55- 13.45 Lunch and networking
13.45 – 15.00 Session 3: Breaking bad news
15.00 - 15.15 Coffee break
15.15 - 15.45 . ‘Ask the Panel’ (Opportunity for questions and discussion with all
contributors)
15.45 – 16.00 Closing Remarks

Our strategy to 2020: key aims
Improving the emotional experience of care before,
during and after treatment or donation:
We want:
clinics to acknowledge how
emotionally difficult infertility and
treatment can be, and act on this
an improvement in the experience
of treatment, with minimal
emotional harm
better support for donor conception
treatment
support from the clinic after
treatment to become the norm
We will:
define ‘excellent support’, including for
donor conception treatment
make it a core message
focus more on quality of support at
inspections
seek feedback from patients on their
emotional experience of care in their
clinic

Consistent
outcomes and
support
Access
Access to treatment and
donation
Outcomes
The best possible
treatment outcomes
Value
Value for money
Support
Support before, during and
after treatment
’Support’: our 2020 strategy in practice
• Code of Practice Update: new requirement for clinics to each have a Patient Support Policy etc.
• Production of HFEA Guidelines on emotional care
• Engagement with clinic staff: E.g. Conference, C of P consultation
• Engagement with patients – national patient survey and specific feedback on emotional support
pathway
• Engagement with professional organisations. E.g. BFS Training module for clinic leaders, BICA
• Production of resources available for download from HFEA Clinic Portal website for clinics
• Patient support skills training days in London and Manchester for clinics
• More focus on emotional care & support at inspections to ensure compliance with Code of Practice
requirements

Guidance Note 2 (Staff)
2.6 Centre management should ensure that staff members who are in contact with patients, donors and their
partners (where applicable):
(a) Follow the centre’s ‘patient support policy’
(b)Are prepared to offer appropriate emotional support to people suffering distress at any stage before, during
and after treatment
(c) Understand and can explain the role of counselling, and
(d)Know when and how to refer people to the centre’s qualified counsellor
2.7 Centre management are responsible for delivering the patient support policy and for using intelligence to
monitor and evaluate the effectiveness of the policy. Centre management should ensure that the policy
addresses the emotional support needs of patients, donors and their partners (where applicable) in order to
continuously improve their experience of treatment services
C of P Changes – Patient Support

Guidance Note 3 (Counselling and Patient Support)
[whole sub-section on patient support is a new addition]
Patient support
3.14 The centre should develop a ‘patient support policy’ to outline how the centre ensures that patients, donors and
their partners (where applicable) receive appropriate psychosocial support from all staff they encounter before, during
and after treatment. Psychosocial support is delivered by all members of staff and includes, but is not limited to, access
to counselling. All patients, donors and their partners (where applicable) should be treated with sensitivity and respect
and supported through all aspects of their treatment and, in particular, if they are suffering distress at any stage. Patient
support should be patient-centred and as far as possible centre staff should adapt the support offered to a patient
according to their requirements and preferences. Centre staff should be sensitive to any ethnic, religious, societal,
cultural or other factors which may influence the kind of support which is appropriate for an individual.

It should contain a statement about
• What patient-centred care is and how this will be delivered by the centre
• The role of individual staff members in supporting patients and managing their expectations
• The written/online information that the centre expects patients to be able to access
• What the centre will provide in terms of group support (events, open evenings, signposting to internal and
external groups, a forum for patients to engage with each other)
• How the centre expects all staff to communicate with patients/donors/partners
• What customised support the centre is going to provide/offer at different stages of treatment and for different
types of patients
• The annual and ongoing training that the centre will provide for staff on patient support, including skills training,
adapted to reflect staff members’ role within the clinic
• How feedback data on the patient/donor experience will be collected
• How the centre will monitor/evaluate its provision of patient support & care as contained in this policy

Guidance Note 23: the Quality Management System
The Quality Management Review
23.12 (extract) The review of the quality management system should include consideration of changes in:
(e) the results of the following activities:
–(i) quality indicators for monitoring the centre’s performance in the provision of emotional support and patient care
generally
Quality indicators
23.16 The centre should establish quality indicators for systematically monitoring and evaluating the centre’s provision of
emotional support and patient care generally.
Assessing user satisfaction
23.17 The centre should assess whether or not the service has met users’ needs and requirements, including the extent
to which they felt supported before, during and after their treatment or donation. It should keep records of the
information it collects and the actions it takes. Methods should include user surveys for all aspects of the service.

Guidance Note 23: the Quality Management System
23.7 Centre management should ensure the quality policy includes a commitment to:
(a)providing a service that meets its users’ needs and requirements. This should include ensuring that all staff who come into
contact with patients, donors and their partners (where applicable) provide good quality supportive care before, during and
after treatment, as outlined in the centre’s patient support policy
23.9 Centre management should establish documented quality objectives. These should:
(a) include objectives needed to meet users’ needs and requirements, including their need for supportive care and treatment
from clinic staff, before, during and after treatment or donation (see guidance note 3.14)
(b) be measurable and consistent with the quality policy, and
(c) be reviewed regularly.

Consistent
outcomes and
support
Access
donation
Outcomes
The best possible
treatment outcomes
Value
Value for money
Support
after treatment
• Engagement with patients – national patient survey and specific feedback on emotional
support pathway
• More focus on emotional care & support at inspections to ensure compliance with Code of Practice
requirements

HFEA National Patient Survey 2018
HEADLINE
• 75% were “satisfied” with their clinic
• A quarter of patients felt the treatment they received was not satisfactory
Fertility Trends 2017 Report
in 2017, 54,760 patients underwent 75,425 treatments
That’s approximately 13,500 people per year dissatisfied with how we are treating them

Q. From which of the following did you or your partner receive emotional support that was helpful?
Please tick all that apply.
(Last two years N=637; Between two and five years, N=295)

Clinic Portal patient support microsite
Sample

Guiding Principles for emotional support
Here you can find nine guidelines to help you provide your patients with the best
emotional support you can.
1.Every member of staff is responsible for the provision of good emotional support
2.Provide and participate in good training
3.Put patients at the centre of their care
4.Tailor care to the needs of different patient groups and to the individual
5.Make every contact with the clinic as stress-free as possible
6.Offer an outstanding fertility counselling service
7.Provide a variety of emotional support resources for patients
8.Staff wellbeing is patient wellbeing
9.Listen to complaints or feedback and act

8 podcasts published… and more to come
• Angela Pericleous-Smith- during treatment
• Jennie Hunt- donor-assisted reproduction
• Suzanne Dark- ending treatment
• Janet Owen- starting treatment
• Kelly da Silva- peer support events at CARE
• Laurel Hird- writing the patient support policy and supporting staff at the Fertility
Partnership
• Kevin McEleny- how Newcastle Fertility Centre supports men
• Julia Paget- how Complete Fertility support patients and use patient feedback

Consistent
outcomes and
support
Access
donation
Outcomes
The best possible
treatment outcomes
Value
Value for money
Support
after treatment
• Engagement with patients – national patient survey and specific feedback on emotional support
pathway
• More focus on emotional care & support at inspections to ensure compliance with Code of
Practice requirements. from 1 October 2019

But…
This isn’t just about a strategy or a policy or compliance
with regulations…
It’s fundamentally about how we treat people

Clinical excellence & bespoke fertility care
Patient Support
PPP
Your speaker
Marion Wilson – General Manager & Head of HR (10th September 2019)
Francesca Steyn – Head of Nursing & Quality (19th September 2019)
Patient Support

Fertility treatment and trying to
conceive can be an extremely anxious
and distressing time for patients.
Our aim at CRGH is to provide
emotional support at the beginning,
throughout treatment and aftercare

NICE Guidelines (2013) explain that treatment and
care should take into account individual needs and
preferences.
At CRGH, we understand that emotional support for
patients should be a multi-disciplinary approach and
that all team members are involved in the patient’s
treatment journey therefore, all team members play
a role in the emotional support at each point of
contact.

1st contact, support and care before
Initial Consultation
Finance and Admin
Egg Collection/Ward
CRGH Support Journey
Nurse Consultations/Care during
Embryology
Pregnancy Test
Aftercare

Our Practice Before
First baby born
free of bowel
cancer gene
Highest series of
live births from
frozen eggs in the
UK (HFEA)
2015
▪ Welcoming
▪ Provide clear precise information, write to patients following consultations
▪ Manage Expectations patient/partner
▪ Assess needs for patient or partner
▪ Explain and support until patient confident

Highest series of
live births from
frozen eggs in the
UK (HFEA)
Our Practice During
▪ Privacy and dignity respected
▪ Offer additional help via patient video’s, infographics, teaching
sessions, additional Nursing appointments
▪ Offer Counselling (mandatory for donor treatment), offer additional
sessions if required
▪ Contact patients during the 2 week wait

First baby born
free of bowel
cancer gene
Highest series of
live births from
frozen eggs in the
UK (HFEA)
2015
Our Practice After
▪ Privacy and dignity respected
▪ Offer additional help through patient video’s, infographics, teaching
sessions, additional Nursing appointments
▪ Offer Counselling (mandatory for donor treatment), additional sessions
if required
▪ Patient Liaison follow-up contact post treatment

First baby born
free of bowel
cancer gene
Highest series of
live births from
frozen eggs in the
UK (HFEA)
2015
We listen, We improve
Patient Feedback is critical to reviewing and
improving our service to our patients

Highest series of
live births from
frozen eggs in the
UK (HFEA)
Signposting and resource
We routinely work with outside organisation’s to provide further emotional
support for our patients and education for our staff:
• Fertility Fest
• The RCN Fertility Nurses Forum
• The HFEA
• The Dovecote
• Saying Goodbye
• Fertility Network UK

Counselling

Highest series of
live births from
frozen eggs in the
UK (HFEA)
• Counselling offered before, during and after treatment
• Gives you the opportunity to consider the effect of infertility on
you and your relationships with others
• It is a chance to take an active role in a process in which, so
often, many people find themselves feeling frustratingly inactive
• Ultimately, it is about taking care of yourself
Further support and Fertility Counselling

First baby born
free of bowel
cancer gene
Highest series of
live births from
frozen eggs in the
UK (HFEA)
2015
We listen, We improve, We continue to evaluate
• Secretaries - Immediately contact patients following the initial consultation and
provide their personal details
• Patient Support – Patient support group
• Patient Liaison - We have a Patient Liaison Officer who contacts patients during the 2
week wait, after the first pregnancy test, courtesy call at 24 weeks and for the
outcome. If applicable at any stage will offer counselling, send flowers
• Patient Feedback – Captured in waiting areas on note pads in scan rooms, encourage
to provide ratings on Facebook and HFEA website
• Patient Response C.O.O & GM, Line Managers respond immediately to any complaints
or issues
• Training – Ongoing investment in staff training across the departments K.P.I’s set
around waiting times, letters and telephone response, quality assessments
• Systems - Salve App went Live August 2019, Q-Pulse September 2019
• Patient Support Policy/Collaboration – Jessica Hepburn from “Fertility Fest” is
currently working with us on evaluating our service and policy

To Finish

Karen Pooley
Senior Andrologist and Quality Manager
The Invisible Man

Patient Support Policy – how we approached it
https://www.picker.org/about-us/picker-
principles-of-person-centred-care/
Team brainstorming session –
What does patient centred care mean?
What do we already do?
Where are the gaps?
All areas of team represented –
Clinicians, Nurses, Scientists,
Counsellor, Admin, Business Managers
Patient surveys – no assumption that
we know what patients want
Policy then written using Picker’s Eight
Principles as a framework to work to,
and incorporating the HFEA CoP (9th
Ed) guidance notes

The problem with men is …
 Engage less frequently than women with healthcare
professionals
 Have fewer support networks and often don’t ask for help
 Inappropriate connection between fertility and virility
 Public discussion of male infertility is not yet the norm
 Often ill prepared for a diagnosis or consultation
The problem with Fertility Clinics is…
 Clinics are inherently female-centric
 Generally apathy in funding research or accurately diagnosing
the root cause of male factor infertility (IVF/ICSI is the cure all)
 Sparse male focused patient literature available in clinics
 Clinics often neglect the male in myriad unintentional and subtle
ways
 Failure to recognise male behavioural patterns for what they are
 Little recognition that men may have very different support
needs to their female partner (or have any needs at all!)

Commonly expressed feelings:
If men don’t naturally seek support and are made to feel unseen/unheard
in our clinics and unable to vocalise how they are feeling, there is
significant potential for huge personal and interpersonal distress.
How can we help?
Fear Isolation
Anxiety
Guilt
Shame
Sadness
Just a sperm provider
Less of a man Anger
Forgotten On the periphery

When do men need support?
Diagnostic Testing &
Therapeutic
Treatment
Fertility
Preservation
Sperm Donors

Podcast on HFEA website by Dr Kevin McEleny
Diagnostic Testing and Therapeutic Treatment
The Stress Point Solutions?
Producing samples
Embarrassed
Inconvenience – time off work, explaining
absence to employer
Fear of / failure to produce
Lab staff show empathy and give reassurance
Flexibility with appointments
Discretion, privacy, comfort of on site production facilities
Allow off-site production
Clear instructions to avoid unnecessary repeats
Getting results/initial diagnosis
Anxiety waiting for results
How the results are given (in person/phone/by
whom)
Understanding/interpretation of complex
results
Lab to keep turnaround times to a minimum
Clear reports with adequate interpretative comments for GP’s
Results to be given by healthcare professional in appropriate manner
(ie not the GP receptionist via telephone!)
Education of GP’s
Provide or signpost to good explanatory patient information
Referral to clinic
Referral paperwork and appointments solely in
female name
Referral to a “gynae” clinic
Use of female name only to call into consults
Female-centric physical environment
Disregard for male factor infertility, poor/limited
investigation of male
No follow up emotional support for male after
initial diagnosis
Male sexual dysfunction – difficult to admit
Build an identity as a centre for male and female reproductive health
(ie not gynae).
Have separate (or at least combined) male and female clinical notes.
Mandatory attendance of male and female at initial OPD
appointments.
Use both partner’s names whenever appropriate (“Matthew and Sarah,
would you like to come through now…”)
Consider clinic design –décor, privacy, layout, to appeal to both male
and female partners. eg. Provide reading material for both.
Take full male history, not just female.
Pursue full male diagnosis where possible and offer treatment options
if appropriate – Urology/Psychosexual counselling/Genetics counselling
Offer professional supportive counselling and foster a culture where it
is seen as totally routine and normal to access this.

Diagnostic Testing and Therapeutic Treatment
The Stress Point Solutions?
Starting Treatment
Fear of unknown, confusion about logistics of
treatment cycles and their role
Concern about sample being mixed up with
another’s
Being able to produce samples to demand in a
clinical environment is daunting
Failure to produce – jeopardises treatment cycle
Made to feel like a producer of sperm
Anxiety that sample is “good enough”
Clear patient instruction and information about how, when and where
semen samples are required.
Staff acknowledgement that its difficult and stressful – normalise their
feelings
Allow off site production if possible/patient prefers
Consider production room design, pay attention to décor, furnishing,
noise, lighting, privacy and dignity
Labelling of the sample pot – Male name, not female!
Lab tours – demonstrate the process their sample goes through,
witnessing protocols etc, if possible.
Encourage to be present for the insemination or embryo transfer – they
are still an important part of the process.
Discuss results of sample, encourage and commend them for doing
their part.
Use of donor gametes
Not fully reconciled to diagnosis or use of donor
gametes
Feels under pressure to use donor sperm so
partner can have a child
No actual role to play
Feelings of hopelessness/uselessness in their
procreative journey, lack of control.
Full and careful professional counselling required
Signpost to specific donor support groups/forums
Ensure all possible avenues have been pursued if the male needs an
absolute diagnosis – but try not to let use of donor gametes be viewed
as a last resort – needs to be framed as a positive choice.
Give back some control to male partner by fully involving in the donor
matching process, taking time to understand his needs/preferences.
Failed treatment
All focus is on female, male feels he isn’t
allowed to grieve/ must be strong for partner
Early Miscarriage/Ectopic pregnancy
Need realistic understanding of success rates from outset – manage
expectation.
Always offer review appointment to both partners and give reassurance
that its not a case of apportioning fault or blame for failure
Signpost emotional support – counselling, miscarriage association
leaflet for partners etc.

Male Fertility Preservation
 Undergoing sterilising therapies due to malignant diagnosis
 Undergoing surgery that impacts on fertility and/or sexual function
 Back up prior to ART
Issues unique to storage patients are:
 Time pressures/emergency referrals
 Often acutely unwell
 Newly diagnosed, potentially life threatening illness, no time to
absorb and come to terms with their diagnosis or its potential
impact on their future fertility.
 May have given no prior consideration to their fertility, desire for a
family, may or may not have a partner
 May feel pressurised to undertake storage (clinical
staff/family/partner)
 Overwhelming amount of paperwork to be completed/decisions
to be made with little time for consideration
 Sensitive questions have to be asked about post-humous use
 Long term follow up/support needs – patient and partners
The mere act of offering gamete preservation is supportive in itself
– even if declined, or unsuccessful.

Before
During
After
• Referral framed as a
positive action
• Access – flexible/urgent
appointments
• Information provision –
no surprises
• Who to bring? Suggest
they bring partner/
family member/friend
for support
• Clinic environment – is
your waiting area away
from the hustle of a
busy fertility clinic? Do
you keep your patients
waiting?
• Staff/Patient interaction
- building rapport,
calming
• Reassurance – it’s OK (and
normal) to be scared/
uncomfortable/worried
• Privacy and dignity –
environmental factors
• Give them some control –
they have choices
• Allow them to talk about
their future (in terms of
fertility and family
aspirations – it may be the
first time they have even
considered it)
• Transparency and
managing expectations -
prepare them for bad
news
• Talk about a Plan B – what
happens if I can’t produce
a sample/there are no
sperm?
• Results giving – good or
bad? Given by the staff
member dealing with
individual case, in person
wherever possible
• Direct contact details –
further questions/issues
• Supportive counselling if
necessary
• Follow up – encourage to
return to check fertility –
but respect their choice
not to.
• Support if post treatment
results are not what they
hoped for
• Deceased patients –
support for partner/family

Fate of cryopreserved samples - Use or Dispose?
 Usage is low (in our facility less than 10% of stored material is ever
used in ART). When deciding to use frozen samples patients need full
information about treatment options based on sample quality,
success rates, risks (eg if stored post treatment)
 Men often prefer not to make a positive decision to remove samples
from storage particularly when they have banked as a result of a
cancerous diagnosis. They may need support, information and advice
when considering their options.
Men find it psychologically comforting to know the samples are there,
even if have no intention of using them, or have conceived naturally post
treatment. Staff need to be sensitive to a patient’s emotional needs.
 Post-humous use/disposal - Support for the bereaved partner
- Support for bereaved family

Sperm Donors
Often taken for granted, we forget what an amazing thing they are doing!
Before During After
Their feelings (and support needs) evolve as they progress through the stages of donation
• Honesty and
transparency with
screening results
• Clear information
provision
• Onward referral if
unexpected issues
discovered
• Personal contact and
encouragement
• Full independent
implications
counselling – involve
partners if applicable
• Build a personal
relationship, they
aren’t a number or a
commodity
• Check as they
progress that they are
comfortable with
their decision to
donate – no regrets
• Ensure their privacy
and confidentiality –
consider clinic design
• Be flexible and
accommodating with
appointments
• Show gratitude for
their time
• An email, card or
letter to thank them
for their involvement
• Outcomes – do they
want to be kept
informed?
• Mediation between
recipients and
donors
• Signpost to HFEA for
future contact
• Professional
counselling support
when identity is to
be released

Summary
 Men play a vital part in the fertility pathway – we can’t help make babies without
them!
 Whatever the reason for being in our clinics, men should have access to the same
amount of support and care as the women we treat.
 Men may need different support to women in a fertility setting – we need to be a
bit better at recognising that and tailoring our supportive practises accordingly.
 Men who feel seen, heard, informed and empowered to make choices and
decisions will ultimately be better at also helping us to support women through
their fertility journey.

Thank you for listening!
karen.pooley@nuh.nhs.uk
The InVisible Man

Customer Service Skills
HFEA PATIENT SUPPORT – SKILLS
TRAINING LONDON SEPTEMBER 2019
Angela Pericleous-Smith
Chair of the British Infertility Counselling Association
Specialist Fertility Counsellor – Leeds Fertility

Customer Service
Your Experiences?
BICA workshop/HFEA workshop 2019

Pay attention to:
• Emotions you were feeling
• Physical sensations you may have experienced
• Your feelings afterwards
• What specifically made the experience
inadequate/poor/bad?

Feedback – Common themes

Your Expectations Prior?

Our Patients’ Expectations?

The clinic team will:
• Understand their journey to date
• Understand how it feels to be in a clinic
• Understand how important this is to them

The clinic team will :
• Treat them in a friendly and professional manner
• Treat them as important
• Run their appointments to time
• Understand and listen to their concerns
Patients’ expect:
• Their practitioner will have read their notes
• Accessible appointment and waiting times i.e. early evening/weekends
• Treatment will be funded (maybe even multiple cycles funded)
• Treatment will be successful
• They will have a baby
• Maybe even two babies

Common Issues our Patients’
Experience?

Common Issues our Patients’
Experience?
• Telephone calls not answered
• Passed from one staff member to another
• Receiving different information from clinic members
• Medical staff not having read notes beforehand and having to go through
the pain of their history yet again
• Being kept waiting e.g. out of work on their lunch break
• Appointments being cancelled by letter – “unforeseen circumstances”
• Feeling their symptoms are not taken seriously
• Feeling like they are asking “stupid” questions
• Fearing being viewed as a mad or bad patient
• Not being able to get an appointment with their doctor for 6 weeks
• Test results lost and having to be repeated
• Lack of privacy
• Feeling they are “a number on a conveyor belt”

COMMUNICATION SKILLS

ACTIVE LISTENING
• One of the most therapeutic experiences for
those who are distressed or angry or sad
• Involves making space for your patient to
express their feelings and thoughts
• Paying close attention to what is being said
• Demonstrating that you are interested and
curious to know more

Active listening:
Barriers:
• Trying to listen to more than one conversation at a time
• Not interested in what the patient is saying
• Distracted by your mobile phone
• Distracted by other noises
• Reading the patient’s notes
• Looking at the computer screen
• Lack of eye contact
• Inappropriate posture – leaning forward, swinging on a chair etc.
• Doodling, fidgeting, looking at watch, yawning
• Lack of head nods
• Lack of facial expressions

Ability to Empathise
“The ability to share someone else’s feelings or
experiences by imagining what it would be like to be in
that person’s situation” (Cambridge Dict.)
• Speaking and listening without empathy will be a
negative experience for the patient it implies that
you don’t genuinely care
• Patients often say how warm and concerned the
practitioner was or how coldly professional
• Sympathy implies feeling (unhelpfully) sorry for the
person

Language
Think about your terminology
• Great sensitivity about language
• Be honest and realistic
• Keep language simple and jargon free
• Plain language makes your messages
easier to absorb

What are the challenges for clinic
staff?

What are the challenges for clinics?
• Resources – human and physical
• Developing Healthy Team Ethos
– Staff turnover
– Staff will leave if they feel undervalued
– Inclusive Teams
– Frontline staff heard
• Better support and training for staff
Can basic standards be written into your policy?

Hear Listening to the patients story
Empathise Use phrases that convey that you
understand how the patient feels
Apologise and do so effusively
Resolve Fix the issue and if you don’t
know how ask the patient
“how can I make this right?”
Diagnose Get to the bottom of the issue
so it wont happen again

Show your patients how important they are to
you by interacting in a friendly, positive and
attentive manner
Good customer service means meeting
expectations
Excellent customer service means
exceeding their expectations

Thank-you for listening
(actively)!

Giving and Managing
Bad News
Jennie Hunt
Senior Accredited Member of BICA
BICA/HFEA workshop 2019

What is bad news?
Bad news is “any information that produces a
negative alteration to a person’s expectations
about their present and future”
(Fallowfield, Lancet 2004)

How is it for us?
• Every member of the team will need to give
bad news at some point
• Ranges from cancelled appts to negative
outcomes
• Giving bad news is hard for the messenger
• “Don’t shoot the messenger” ?
– In fact the messenger can easily increase the
distress felt and may be long remembered

Be self aware
Discuss with your group what you find hard
about giving bad news

Reactions to bad news
“The impact of bad news is proportional to its
effect in changing the patient’s expectations”
Stanford medicine 2019
• Our patients are often extremely anxious and
therefore vulnerable
• For them the stakes are very high – their
hopes and dreams for the future depend on
us

Managing Bad News
ABCDE Model

A – Advance Preparation
• Take a few minutes to prepare yourself
emotionally - leave the last task behind
• Find a sufficiently private space
• Think through what you need to tell them,
have you got all the information you need?
• Consider what impact it will have
• Be clear about the time you have available

B – Build Rapport
Face to face session:
• Greet them warmly and say you name/your role –
the relationship starts here
• State what the session is about e.g. “I have your
results and would like to explain them to you”
• Look at them, not your paperwork
• If it’s a couple, address both
• Ensure your body language is open and facial
expression is appropriate

B – Build Rapport .. continued
Telephone session:
• Is there background noise/voices? Can you get
more privacy?
• Say you name/your role and state what the call is
about
• Ask if this is a good time
• Your voice will convey warmth or lack of it
• Your facial expression will be ‘heard’ by the
patient even if it cant be seen

C – Communicate Well
• Keep the information simple and clear
avoiding acronyms and jargon
• Be empathic – that is what will be
remembered and talked about
• “Empathy is the ability to understand and
share the feelings of another” (Oxford English Dict.)
• Don’t rush to fill silences
• Check that they have understood

C – Communicate Well continued
• Repeat anything that is not understood
• Check if they feel able to hear more
• Welcome /encourage questions
• Summarise the news
• Explain next steps
• Provide/offer written information if available
• Accept that shock/distress limits ability to take
in/recall what is said

D – Deal with their reactions
• Listen carefully and notice how they are
reacting
• Don’t interrupt - wait for a pause
• Demonstrate your concern “ I am so sorry ….”
“I can see this is very hard for you”. “You are
finding this difficult to understand …”
• Be prepared for anger, tears, silence or
confusion
• Respect any desire to leave/end the call early

E – Encourage and validate emotions
• Acknowledge emotions and normalise them -
“of course this is a terrible shock.” “I
appreciate that this is very upsetting.”
• Check if they would like time alone
• Ask what support they will have
• Ensure they know the availability of
counselling + contact details and encourage
this

Time keeping
• It is important not to end the discussion
suddenly
• Be aware of the time and give them prior
notice “ we have just five minutes left …”
• Allow time to ask whether they have more
questions today.
• Acknowledge that time has been limited and
let them know when they can talk again

Professional support
• The messenger needs support to be the best
that they can be.
• A chance to debrief, share feelings and reflect
• If you have recently received bad news, it
might be best to step back from this task
• Its OK to ask for help

Start a list of what you would like to
change in your clinic setting that
would make giving bad news a better
experience for you and your patients.

Reflections on your experiences

Patient support workshop presentation

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