Health Psych 5 - Dr/Patient

Question 1

Levison (1997) study on suing

Answer 1

Dr who were not sued:
>longer consultations by 3 mins
> opened communication
> set a specific agenda for the patient
> humour and active listening

Question 2

Is bad news objective or subjective?

Answer 2

Subjective:

> a hand amputation is much worst news for a pianist than a oral speaker.

Question 3

What are the stress level graphs?

Answer 3

Dr has stress before breaking bad news;

Patient has stress after the conveyance of bad news

Question 4

Importance of studying ‘bad news’?

Answer 4

1. It is a frequent and stressful task
2. Patients want the truth
3. Ethical and legal imperatives: up to the practitioner to disclose as much info as necessary
4. Clinical outcomes: how it (bad news) is discussed can affect hopefulness, satisfaction with medical care, comprehension etc.

Question 5

What is SPIKES protocol for bad news?

Answer 5

S- etting (privacy, family etc)
P- atient perception (assess what they know; open ended questions)
I- Invitation from the patient (do you want to know it all at once, or do you want to know it a little bit over time?)
K- nowledge: giving medical facts (warning shot, avoid jargon, bluntness; give info in small chunks)
E- xplore emotions and empathise
S- trategy and summary (elicit patient’s understanding, discuss further steps)

Question 6

What is SPIKES protocol for bad news?

Answer 6

S- etting (privacy, family etc)
P- atient perception (assess what they know; open ended questions)
I- Invitation from the patient (do you want to know it all at once, or do you want to know it a little bit over time?)
K- nowledge: giving medical facts (warning shot, avoid jargon, bluntness; give info in small chunks)
E- xplore emotions and empathise
S- trategy and summary (elicit patient’s understanding, discuss further steps)

Question 7

What are the 4 main objectives of consultation for bad news?

Answer 7

1. Gathering info from the patient
2. Transmitting the medical info
3. Providing support to the patient
4. Eliciting patient’s collaboration in developing a strategy or treatment

Question 8

Barriers for patients and doctors in addressing psychological issues

Answer 8

Patient:
> Time constraints of the doctor
> Embarassed and dont want to bring up the subject
> Fear own expression and emotional reaction

Doctor:
> Time constraints
> embarrassed at lack of knowledge and expertise
> attitude and fear of vulnerablity

Question 9

Factors for ensuring disclosure of information

Answer 9

> Open ended questions like, “So you say you are feeling emotional, is this something that you have experienced in the past or may it be a new symptom?”

> Focus on clarifying psychological issues and not just physical issues

> Empathetic statements, active listening and educated guessing

> Summarising

Question 10

Duric (2003) study on breast cancer cues

Answer 10

> If first emotional cue was attended to with empathy then responded with more cues
women receiving empathetic response reduced depressive symptoms 3 weeks later

Question 11

What does empathetic and effective communication lead to?

Answer 11

> Faster recover
Greater cooperation with treatment
Fewer post hospital complications

Question 12

Victorian cancer council communication skills course

Answer 12

Emotional cues;
How to deliver bad news;
Discuss the transition to palliative care with patients and family;
Discuss sexuality;
Complementary and alternative medicine;
Discuss death and dying