1. The document outlines steps for communicating with patients, including checking identification, confirming the agenda, asking about their knowledge and expectations, breaking bad news empathetically, assessing their feelings, explaining the disease simply, discussing management and support, emphasizing further care, summarizing, and checking understanding. 2. It recommends assessing social factors like their job, living situation, and finances, as well as smoking and drinking history. 3. Key ethical principles of autonomy, justice, beneficence, and non-maleficence should guide patient communication.

1. Communication - station 4
By Dr.Sadek Al-Rokh
1- Check hands with the surrogate
2- Identify you self
3- Confirm the patient identify
4- Confirm agenda of meeting and take permission of discussion
5- Ask if he want anyone else to attend the discussion ( if breaking bad
news or counseling for chronic illness ) .. Absolutely don’t in cases of
confidentiality like Counseling for HIV
6- Ask open question how much he know about his condition
7- Ask him about his expectation ( if breaking bad news or counseling
for chronic illness )
8- Start with breaking of the news with ( the golden area of showing
empathy and sympathy and needs some tragedy acting) : ( the
results of the blood test or imaging has been released and its as not
we hope .. stop for a while , it reveals that you have disease called …
or cancer .. stop for a while and let the patient to express his feelings
.. then tell him I’m really sorry for these bad news today ..
9- then ask him : how do u feel now ? .. show your empathy again : I
appreciate your feelings , and be sure that we will help you as much
as we can .
10-Ask him how much do you know about this disease? do you want me
to explain more about this disease for you ( Explanation of the disease) ?
 Start to explain what is the disease simply avoiding jargons ( medical
terms )
 explain symptoms and complications of the disease
 explain the main points of management plan and referral to
specialized doctor or to multidisplinary team to give him the proper
care and treatment

2. Social history
 Patient job ? and how much his or her symptoms affect her or his job
and usual daily activity ?
 With whom the patient is living ? Who supporting him or her at
home?
 Financial support?
 Smoking and alcohol history ?
12 – Emphasize again for these bad news today , I know how much its
hard for you , but be sure that we will do our best to give you the full care
13 - concern ? any other concern ? if didn’t ask about the concern you
lost all the exam .
14 – Summarize your meeting with him in brief : I’m going to
summarize the important points in our discussion today.
15- Check understanding, by asking may I know please how much
did you get from our discussion today? N.B : Don’t check understanding if
the case is dealing with angry patient as he is not in situation to check his
understanding
15- Help : I’m sorry again for hard news today , I will give you some
leaflets , brochures , websites to know more about the disease , I will give
you my contact number as well to call me if you have any worries ant time
.. Anyone to drive you home?
16- Any other questions? Nice to meet you – check hands.
Regards

3. The fixed ethical issues for every case of
communication are :
 Autonomy : the patient has the right to know about his condition
and to share the management plan
 Justice : the patient has the right to be treated regardless his race ,
color or religion
 Beneficence: to do good for the patient
 Non maleficence : not to do harm for the patient