Management of selected non-pain Flashcards Preview

Geriatrics > Management of selected non-pain > Flashcards

Flashcards in Management of selected non-pain Deck (32):
1

What are the three steps of giving bad news?

Ask-Tell-Ask

2

What are the steps in communicating serious news?

-Prepare
-Establish their understanding
-Determine how much pt wants to know
-Deliver info
-Respond to pts feelings
-Ascertain pts understanding
-Organize plan and f/u

3

True or false: you should deliver bad news over the phone if possible so that the pt can react in privacy

False

4

What are the questions to ask to establish the pts understanding?

What have other drs told you?
How sick are you?
How is illness impacting your life
What can't you do that you wish you could?

5

True or false: pts have the right to be told the truth AND to decline to learn unwanted info

True

6

Why is it important to use a warning shot in conversation?

To have pt pay attention

7

What are the two steps to do after delivering serious news?

Response to feelings
Organize a plan and f/u

8

Is it okay to send pts to others to provide bad news?

If you have to, yes

9

What are the four things that better communication does for patients?

- improves pts adjustment
-lessens pain/symptoms
-Increases adherence to plan
-Increases pt satisfaction

10

What are the three things that better communication does for physicians?

1. Increases enjoyment
2. Decreases stress/burnout
3. Decreases malpractice

11

What is the most important skill to acquire for physicians in talking about serious news?

Ability to detect and respond to pt emotions

12

Should you refrain from fixing pts emotions?

Yes

13

What are the steps of verbal acknowledgement?

Name emotion
Understand emotion
Respect pt
Support pt
Explore emo

14

How can you improve non-verbal acknowledgement?

Face squarely
Open body
Lean toward
Use eye contact
Relax body posture

15

What is the most powerful non-verbal communication?

Combination of expertise, commitment and integrity

16

True or false: Emotional data > cognitive date

true

17

What is the common pitfall with discussing prognosis? Solution?

Assuming you know what the pt wants

Sol = ask how they want to talk about prognosis

18

What is the correlation is between wanting to know info and edu level?

Direct

19

What is the correlation is between wanting to know info and advancing illness?

Advanced = less wanting to know

20

What are the three general types of people's response to prognosis?

1. Want details
2. Big picture
3. None

21

What should you do with pts who don't want info?

1. Figure out why
2. Acknowledge concern
3. Ask to revisit later
4. Make decision if prognosis might change perspective

22

What should you do with pts that are ambivalent?

-name ambivalence
-Explore pros and cons
-Acknowledge difficulty
-Consider outlining options for discussion

23

Can a prognosis destroy hope?

It can, doesn't have to

24

What is the common pitfall to end of life? Solution?

-Cheerlead until there is absolutely nothing left
-Solution = work on big pictures and goals that are still achievable

25

When should you offer a recommendation? What should you do, when you do this?

After you have heard the pt--ask for feedback about proposal

26

What type of questions should you ask pts when transitioning to end of life care?

Big pictures

27

What are the three responses to the transition to end of life care conversation?

-Accept
-Negotiate
-Decline dr's assessment

28

What will pts remember about the conversation toward the end of life?

How you said it, not what you said

29

What is the pitfall in talking about dying? Solution?

Opening discussion with DNR, and asking about every single part

Solution = Guide pt via big picture, plan, and make a recommendation

30

What should you close with, with a DNR discussion?

Tell pt that you will document the conversation and write an order

31

What is the one phrase the Dr. Hirsch will haunt you if you say?

"There is nothing more I can do for you"

32

How should you frame good-byes?

Appreciation of them, and ensure that you will follow them