Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
BREAKING
Prof.Dr. Utham Murali.
Dept.Of Surgery
D Y Patil Medical College
Mauritius.
QUOTE -
Contents of Discussion
 Definition / Examples
 Facts of Bad News
 Methods / Protocols
 Description of 1 method
 Key P...
What is Bad News?
 ‘Situations where there is either a feeling of no hope, a
threat to person’s mental or physical wellbe...
Examples
 Life threatening illness. eg: Cancer, HIV
 Degenerative conditions. eg: Alzheimer /
dementia
 Chronic illness...
Other Situations
 Disease recurrence / spread of disease,
or
 Failure of treatment to affect disease
progression,
 Irre...
Why should it be done?
 Forms part of clinical practice.
 A skill that can be taught and improved.
 Patients and relati...
Why should it be done?
 Better psychological adjustment by
patient.
 Reduces stress in doctors.
 Facilitates open discu...
So,
 Bad news is, therefore, a relative
concept and should depend on the
 patient’s interpretation of information
and re...
Why is it difficult ?
The Patient’s Perspective
 Patients often have vivid memories of
receiving bad news.
 Negative exp...
Why is it difficult ?
The Physician’s Perspective
 Fear of causing pain / being blamed / fear of
therapeutic failure / em...
To Whom the BBN to be Given ?
 Certain legal and ethical guidelines in clinical
practice make it difficult to withhold im...
Example -
 If a patient is deemed to be psychotic, and
presumably may not understand what has
happened, there may be reas...
Who should give the Bad news ?
 For several reasons, it may be more
appropriate for another doctor to break
bad news.
 F...
Contd -
 The GP usually has an established relationship
with the pt and presumably could anticipate
some of the problems ...
When should bad news be given ?
 You can try gradually to break the news; this in
turn gives the patient and relatives ti...
Example -
 If the patient has an infectious disease or
condition (e.g. hepatitis C or HIV
infection), he or she can inadv...
What do patients want?
For themselves…
 more time to talk
 and show feelings
From the doctor…
 more information, caring...
Methods to Deliver -
 Rabow and Mc Phee’s - ABCDE approach.
 Baile & Buckman - SPIKES approach.
 SAAIQ emergency approa...
ABCDE Approach -
 A dvance preparation .
 B uild therapeutic environment .
 C ommunicate well.
 D eal with patient and...
SPIKES Approach -
 S etting up in privacy.
 P erceptions of the patient.
 I nvitation to break news.
 K nowledge.
 E ...
SAAIQ Approach -
 SET the scene as soon as possible.
 ASSESS the understanding of the
attendant.
 ALERT them that I hav...
BREAKS Approach -
 B ackground
 R apport
 E xplore
 A nnounce
 K indling
 S ummarise
SAD NEWS Approach -
 S et up & Sit down
 A sk , don’t tell
 D eliver the news
 N o fancy lingo
 E xpect, permit & res...
 SPIKES APPROACH
S etting the Environment -
 Provide privacy
 Introduce self
 Determine who else should be present
 Ensure no interrupt...
Perception
 Ask what he already
knows about the
medical condition or
what he suspects.
 Listen to level of
comprehension...
Invitation - Information
 Ask patient if s/he
wishes to know the
details of the medical
condition and/or
treatment.
 Acc...
Knowledge
 Deliver the message
 Use plain language
 Be mindful of body language
 Get to the point
 Give information i...
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
 Acknowl...
Response to Reaction -
If pt Cries -
 Allow sometime to cry.
 Could say, “I can see you are very upset”
 Could touch the patient appropriately...
If pt – Angry
 Defensive or irritation with patient are
unhelpful.
 Acknowledge patient’s position and avoid
talking abo...
If pt refuses – Accept Diagnosis
 Explore reasons for patient’s denial.
 Do not be combative.
 Appreciate that there is...
Common Pitfalls -
 Inadequate time / information.
 Failure to elicit patient’s understanding of
situation.
 Giving news...
Lay Synonyms for Medical
Terminology
Medical Term Medical Acronym Lay Equivalent
 Cardiac arrest Code Heart stopped
Patie...
Unclear
 "Your mother has had a
severe IC bleed. She is
in the ICU and has been
intubated and ventilated.
Neurosurgery ha...
More Clear
 "Your mother has had a
severe IC bleed. She is
in the ICU and has been
intubated and ventilated.
Neurosurgery...
Communication of BBN
 Communication is a 2-way street
 Patients also have to be honest with us
regarding their symptoms,...
Key points
 Delivering bad news is an important part of
a physician's job.
 The manner in which the news is delivered
to...
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, t...
Practice makes a man.. perfect
Upcoming SlideShare
Loading in …5
×

Breaking Bad News - Easy to Break

12,489 views

Published on

BBN - Breaking Bad News is difficult task for Junior doctors in India as it was not in the Curriculum unlike Western countries. So this slide will give you the Facts / Methods with Description of one method & Key points.

Published in: Health & Medicine
  • Hello! I have searched hard to find a reliable and best research paper writing service and finally i got a good option for my needs as ⇒ www.HelpWriting.net ⇐
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • 5 Steps To Cure Your Vitiligo. Drug And Pharmaceutical Companies Hate This! Click Here To See How ➢➢➢ http://tinyurl.com/y4d5dqxj
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Hello! I can recommend a site that has helped me. It's called ⇒ www.WritePaper.info ⇐ So make sure to check it out!
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • make your breasts bigger without surgery! NO PILLS NO CREAMS 100% NATURAL. FIND out more now! ▶▶▶ https://t.cn/A6Li7dmy
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Sie können Hilfe bekommen bei ⇒ www.WritersHilfe.com ⇐. Erfolg und Grüße!
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here

Breaking Bad News - Easy to Break

  1. 1. BREAKING Prof.Dr. Utham Murali. Dept.Of Surgery D Y Patil Medical College Mauritius.
  2. 2. QUOTE -
  3. 3. Contents of Discussion  Definition / Examples  Facts of Bad News  Methods / Protocols  Description of 1 method  Key Points
  4. 4. What is Bad News?  ‘Situations where there is either a feeling of no hope, a threat to person’s mental or physical wellbeing, risk of upsetting an established lifestyle, or where a message is given which conveys to an individual fewer choices in his or her life.’ Bor et al., 1993  ‘...any information which adversely and seriously affects an individual’s view of his or her future’. Buckman, 1992  ‘...any information that is not welcome’. Arber and Gallagher, 2003  ‘...[an] uncomfortable experience for both the giver and the receiver’. Aitini and Aleotti, 2006.
  5. 5. Examples  Life threatening illness. eg: Cancer, HIV  Degenerative conditions. eg: Alzheimer / dementia  Chronic illness. eg: Rheumatoid arthritis / Systemic lupus erythematosus  Mental retardation in children. eg: Downs syndrome / Cerebral palsy
  6. 6. Other Situations  Disease recurrence / spread of disease, or  Failure of treatment to affect disease progression,  Irreversible side effects, results of genetic tests, or  Issue of palliative care and resuscitation.
  7. 7. Why should it be done?  Forms part of clinical practice.  A skill that can be taught and improved.  Patients and relatives appreciate it.  The degree to which news is bad depends on the gap between reality and patient’s perception.  Non disclosure is no longer considered ethical.
  8. 8. Why should it be done?  Better psychological adjustment by patient.  Reduces stress in doctors.  Facilitates open discussion among patients, relatives and doctors.  Empowers patients by allowing them a greater say in treatment.
  9. 9. So,  Bad news is, therefore, a relative concept and should depend on the  patient’s interpretation of information and reaction to it.
  10. 10. Why is it difficult ? The Patient’s Perspective  Patients often have vivid memories of receiving bad news.  Negative experiences can have lasting effects on anxiety and depression  Can facilitate adaptation to illness and deepen the patient-doctor relationship
  11. 11. Why is it difficult ? The Physician’s Perspective  Fear of causing pain / being blamed / fear of therapeutic failure / emotional reaction  Lack of training in breaking bad news  Lack of time / health system constraints / lack of support from colleagues  Cultural constraints / language barriers  Fear of upsetting the patient’s existing family roles or structure.
  12. 12. To Whom the BBN to be Given ?  Certain legal and ethical guidelines in clinical practice make it difficult to withhold important and personal information.  It is good practice first to discuss these situations with a colleague or within a multidisciplinary health care team.  There are some specific situations in which you may need to consider whether to give bad news.
  13. 13. Example -  If a patient is deemed to be psychotic, and presumably may not understand what has happened, there may be reason to withhold bad news.  When treating a child, one usually confers with the parent or guardian before breaking bad news.
  14. 14. Who should give the Bad news ?  For several reasons, it may be more appropriate for another doctor to break bad news.  For example, a patient sent to a hospital for special tests may still expect his or her GP to reveal the results, rather than the hospital consultant.
  15. 15. Contd -  The GP usually has an established relationship with the pt and presumably could anticipate some of the problems that might arise.  Giving bad news usually requires time, so it may be inappropriate for someone to do so at the end of a shift.  It may be preferable to hand over the task to other colleagues, provided they are fully briefed and acquainted with the case.
  16. 16. When should bad news be given ?  You can try gradually to break the news; this in turn gives the patient and relatives time to adjust.  On the other hand, withholding the news may deny them the opportunity to face up to it and begin to make the necessary adjustments in their personal lives.  In some situations, it can actually be hazardous to withhold bad news until a later stage.
  17. 17. Example -  If the patient has an infectious disease or condition (e.g. hepatitis C or HIV infection), he or she can inadvertently infect someone else, or be denied the benefits of early medical information if not fully informed of this condition.
  18. 18. What do patients want? For themselves…  more time to talk  and show feelings From the doctor…  more information, caring, hopefulness, confidence  a familiar face
  19. 19. Methods to Deliver -  Rabow and Mc Phee’s - ABCDE approach.  Baile & Buckman - SPIKES approach.  SAAIQ emergency approach - Pakistan  BREAKS approach by IJPC  SAD NEWS approach – Q.U / Canada
  20. 20. ABCDE Approach -  A dvance preparation .  B uild therapeutic environment .  C ommunicate well.  D eal with patient and family reactions  E ncourage and validate emotions
  21. 21. SPIKES Approach -  S etting up in privacy.  P erceptions of the patient.  I nvitation to break news.  K nowledge.  E motions.  S trategy.
  22. 22. SAAIQ Approach -  SET the scene as soon as possible.  ASSESS the understanding of the attendant.  ALERT them that I have bad news .  INFORM in clear, understandable words.  QUICKLY repeat summary of the situation.
  23. 23. BREAKS Approach -  B ackground  R apport  E xplore  A nnounce  K indling  S ummarise
  24. 24. SAD NEWS Approach -  S et up & Sit down  A sk , don’t tell  D eliver the news  N o fancy lingo  E xpect, permit & respond to emotion  W ait  S upport & Summarise
  25. 25.  SPIKES APPROACH
  26. 26. S etting the Environment -  Provide privacy  Introduce self  Determine who else should be present  Ensure no interruptions  Provide comfortable space  Create welcoming environment
  27. 27. Perception  Ask what he already knows about the medical condition or what he suspects.  Listen to level of comprehensions.  Accept denial but do not confront at this stage.
  28. 28. Invitation - Information  Ask patient if s/he wishes to know the details of the medical condition and/or treatment.  Accept patient’s right not to know.  Offer to answer questions later if s/he wishes.
  29. 29. 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
  30. 30. 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
  31. 31. 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
  32. 32. Response to Reaction -
  33. 33. If pt Cries -  Allow sometime to cry.  Could say, “I can see you are very upset”  Could touch the patient appropriately.  After a few moments you should continue talking even if patient continue to cry.
  34. 34. If pt – Angry  Defensive or irritation with patient are unhelpful.  Acknowledge patient’s position and avoid talking about it.
  35. 35. If pt refuses – Accept Diagnosis  Explore reasons for patient’s denial.  Do not be combative.  Appreciate that there is an information gap and try to educate the patient.  Check that patient has a clear understanding of the problem.  Empathize with patient.  Get family members involved if appropriate.  Give time to adjust to new information.
  36. 36. Common Pitfalls -  Inadequate time / information.  Failure to elicit patient’s understanding of situation.  Giving news at doctor’s speed.  Not allowing time for responses.  False reassurances about the future.  Allowing denial to remain.  Removing all hope.
  37. 37. Lay Synonyms for Medical Terminology Medical Term Medical Acronym Lay Equivalent  Cardiac arrest Code Heart stopped Patient died  Anoxic encephalopathy Brain damage  Cardiopulm - resuscitation CPR Resuscitation/Reviving  Cardiovascular Accident CVA Stroke  Intracranial Bleed IC Bleed Stroke  Subarachnoid hemorrhage SAH Stroke  Myocardial infarction MI Heart attack  Cancer/Malignancy CA Cancer  Renal failure ARF Kidney failure  Dialysis Kidney machine  Respiratory failure Breathing failure  Ventilator Vent Breathing machine Life support
  38. 38. Unclear  "Your mother has had a severe IC bleed. She is in the ICU and has been intubated and ventilated. Neurosurgery has placed a ventriculostomy to reduce the pressure in her brain. We do not anticipate a good prognosis.”
  39. 39. More Clear  "Your mother has had a severe IC bleed. She is in the ICU and has been intubated and ventilated. Neurosurgery has placed a ventriculostomy to reduce the pressure in her brain. We do not anticipate a good prognosis.”  "Your mother has had a severe stroke. She is in the intensive care unit and has been placed on life support. The brain surgeons have inserted a tube to reduce the pressure in her brain. We do not think she will survive."
  40. 40. Communication of BBN  Communication is a 2-way street  Patients also have to be honest with us regarding their symptoms, preferences, and concerns.  Realistic hopes and aspirations can only be generated from honest disclosure
  41. 41. Key points  Delivering bad news is an important part of a physician's job.  The manner in which the news is delivered to family members will have a long lasting effect.  Proper training and experience will facilitate the process.  Remember to treat your patients as you would like to be treated.
  42. 42. 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)
  43. 43. Practice makes a man.. perfect

×