Breaking Bad News Flashcards
What are the 3 main patterns of dying?
Gradual death
Catastrophic death
Premature death
Describe some emotions felt on receipt of terminal illness news
Shock Numbness Disbelief Confusion Sadness
What are the 5 stages of grief?
Denial Anger Bargaining Depression Acceptance
Describe the denial stage of the grief model
Reluctant to discuss illness and treatment
Can be a coping mechanism
Must respect their desire not to know too much
However can be a barrier to good care
Describe the anger stage of the grief model
Looking for someone to blame and lashing out
Can be difficult to talk to these patients
Try to search for second opinions and alternative therapies etc
Describe the depression stage of the grief model
May experience a great sense of loss
May become very socially isolated
Offer these people help
Describe the acceptance stage of the grief model
Come to terms with own mortality
Make funeral arrangements
Spend time and make memories with family and friends
Define bad news
Any information that drastically alters a patient’s view of their future for the worse
What are the difficulties for the doctor of breaking bad news?
Fear of the patient's reaction Embarrassed about how to offer comfort Desire to protect the patient Fear of being blamed Lack of confidence in communication skills Sense of failure as a doctor Reminders of own mortality
What model do we use for breaking bad news?
SPIKES S = setting P = patient's perception I = invitation from patient K = knowledge E = empathy S = strategy/summary
Describe the setting stage of the SPIKES model
Face to face, avoid informed relatives first Privacy, no interruptions Find out who they want present Introduce everyone in the room Eye contact Stay calm Make sure there are no physical barriers between you and the patient Listen to them
Describe the patient perception stage of SPIKES
Before you tell them the bad news, ask them what they already know
What they think it might be etc
Describe the invitation stage of SPIKES
Need an invitation from the patient to give them information
Ask them how much they want to know
Don’t assume they want to know everything
Describe the knowledge stage of the SPIKES model
Give a warning shot Give the information in small chunks Allow time for them to consider and ask questions Check the patient understanding Avoid jargon
Describe the empathy stage of the SPIKES model
Ask how they are feeling
Normalise their emotions
Listen to their concerns
