Sharing Bad News powerpoint

RemindersTurn off all pagers, cell phones, and

computers during this educational session.

You are required to participate in the group debriefing session when you have completed the Standardized Patient (SP) encounter.

Please complete the “Pre-Program Self Assessment: Confidence Level” form

Effective Patient Communication Module 2: Sharing

Bad NewsModule development supported by a grant from the

Picker Institute / Gold Foundation 2010 Challenge Grant

3

Learning ObjectivesDefine bad newsDemonstrate use of the SPIKES model

when sharing bad news with the patientDuring the patient encounter, attend to

the major emotional components of sharing bad news, especially expressions of fear, anger, sadness, denial, and guilt

4

Expected OutcomesRecognize 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

5

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)

6

What is Bad News?Information that negatively alters the patient’s view of the future

(Buckman, 1992)(Tissot, 1872)

7

Challenges

(Siegmund, 2008)

Lack of: GuidelinesTrainingExperienceGood role models

Concerns of:The providerThe patient & family

8

Supporting Patient & ProviderPatient & Family are supported by:

Being included in conversations & planningBeing treated as care partners

Provider is supported by:Training & Practicing good communication

skillsLearning ways to effectively cope with

emotionally charged issuesHaving another person available who knows

the patient

9

SPIKES Model: The Six Steps

SettingPerceptionInvitationKnowledgeEmotionsStrategy & 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.

10

Setting the EnvironmentProvide privacyIntroduce selfDetermine who else should be presentEnsure no interruptionsProvide comfortable spaceCreate welcoming environment

11

PerceptionPrepare before

speakingAsk about patient’s

perception of what is going on

(Renoir/ Bjoertvedt, 2010)

12

InvitationAsk questions to

invite the patient into conversation

Ask how much information the patient wants to hear

(Pissarro, 1881)

13

KnowledgeDeliver the message

Use plain languageBe mindful of body languageGet to the pointGive information in small chunks PauseWait for reaction

Use “teach back” to verify that message was received

14

Emotions and EmpathyBe prepared for patient’s and family’s

emotional responseAnticipate fear, anger, sadness, denial,

guiltBe mindful of your own responseComfort the patient

15

Strategy and SummaryAssess patient’s readiness for planning

Negotiate next stepsVerify support structureAcknowledge & answer questions

Summarize planUse “teach back” technique Follow-up

16

Video

©2009 –“Sharing Bad News” Henry Ford Health System Department of Medical Education Video clip used with permission.

17

Discussion of the VideoHow 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

18

What’s Next?

ExpectationsReminders

(Mahmud, 2008)

19

Special ThanksModule Development supported by a grant from the Picker Institute/ Gold Foundation 2010 Challenge Grant

©2009 –“Sharing Bad News” Henry Ford Health System Department of Medical Education

The DHMC Patient and Family Centered Care Department, and Chaplaincy

20

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.

21

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.