Breaking Bad News

Question 1

Resus Tips

Answer 1

• Warn patients of what they will actually see when giving option for them to see resus eg you’ll see a tube down their throat, there is blood and you’ll see someone pumping on their chest
• If 2nd on scene acknowledge everyone in the room say ‘hello, I’m just going to go help my colleagues and then me or someone else will be back to explain what’s going on to you’
• ‘its no longer in _’s interest’
• When stopping TAKE THE END TIDAL OUT otherwise you’ll get the classic end of life movie beep

Question 2

SPIKES Pnuemonic

Answer 2

S etting Up
P erception
I nvitation
K nowledge
E xplore emotions
S trategy and Summary

Question 3

BREAKS Pnuemonic

Answer 3

B ackground - know the pt
R apport
E xploring - knowledge so far
A nnounce - warning shot then info
K indling - check undersand, space 4 emotions
S ummarise - respond to concerns and next steps info

Question 4

ABCDE Pneumonic (Breaking Bad News)

Answer 4

A dvance Preparation
B uild a Therapeutic Relationship
C ommunicatre well
D eal with reactions
E ncourage and validate emotions

Question 5

MANAGED Pneumonic (Breaking Bad News)

Answer 5

M entally setting up
A ble and confident practice
N otice and understand perception
A ccurately and sensitively give info
G ive time for response
E motions, signpost support
D ebrief

Question 6

Examples of warning shots

Answer 6

• ‘unfortunately, I have got some bad news to tell you’
• ‘I am sorry to tell you…’
• ‘Although I would like to give you good news, unfortunately I can’t at this stage’
• ‘We did everything that we could, but sadly…’
• ‘I am so very sorry, but even after all our efforts…’

Question 7

Setting Up (SPIKES)

Answer 7

• Private as possible setting
• Involve signifigant others
• Sit down
• Build rapport

Question 8

Invitation (SPIKES)

Answer 8

• Do you have questions later?
• Does the person want to know every detail of whats going on? (lowkey irrelant for pre-hospital like ofc they want to know if their husband is dying)

Question 9

Knowledge (SPIKES)

Answer 9

• Use lay person language, considering age, background, education level
• Warning shot then give them the knowledge
• Check they understood what you’ve said

Question 10

Explore Emotions (SPIKES)

Answer 10

• Give time for a reaction
• Be empathetic
• Deal with emotion produced

Question 11

Strategy and Summary (SPIKES)

Answer 11

• Ask if anything needs claryfing
• Next steps discussion
• Close disscussion