- Setting
- Private room to speak to patient and / or family
- Involvement of significant others
- Have both parties seated, at eye level
- Look calm, maintain eye contact
- Listening mode: do not interrupt the patient or talk over the patient
- Silent pauses to allow patient to talk
- Repetition as a means to acknowledge what the patient is saying
- Availability – silence phones etc.
- Perception: “before you tell, ask”
- Allows patient’s expectations to be understood – gives an estimation of the “impact” of the bad news, and an opportunity to impart knowledge before breaking bad news or dealing with anger
- Ask patient what they know of the situation
- What did you think was going on when you felt the lump?
- What have you been told about all this so far?
- Are you worried that this may be something serious?
- Take note of the language the patient is using, and use a similar vocabulary
- Do not confront denial head on initially
- Invitation
- Check that a patient really wants to know what is going on before delivering news
- Are you the kind of person who prefers to know all the details of what’s going on?
- Check that a patient really wants to know what is going on before delivering news
- Knowledge or sign posting
- Give patients a warning of what is about to come, so they have more time to mentally prepare
- Sir, unfortunately the news I have is concerning. Would you like me to proceed at this stage?
- Ma’am, I’m so sorry, but I have troubling news.
- Avoid jargon
- Give information in small chunks
- Check understanding at frequent intervals
- Go over information again if news is not acknowledged
- Always check after each “chunk” that the patient is ok to proceed with the discussion
- Tailor the rate of the discussion – slow down if the patient is having difficulty processing
- Give patients a warning of what is about to come, so they have more time to mentally prepare
- Empathy: responding to patient’s emotions
- Do not downplay the severity of the information, or hold information back unless specifically asked
- This may just serve to discredit in the future, or shake trust
- Acknowledge patient’s emotions when they arise, and address them
- Listen for and identify the emotion. If unsure:
- How does this make you feel?
- What do you make of what I have just told you?
- Identify the source of the emotion – e.g. the bad news, delayed diagnosis etc.
- Show the patient that the connection between the above two has been made
- I can see that this news is terribly distressing for you
- Hearing the results of the bone scan is a major shock for you
- Normalize the emotions
- Listen for and identify the emotion. If unsure:
- Such responses validate a patient’s emotions, and reduce isolation
- Do not downplay the severity of the information, or hold information back unless specifically asked
- Strategy and summary
- Summarise the information given to the patient in the discussion
- Check for any concerns or questions not addressed
- Give the patient a plan of action
- Give the patient a safety net and assurance of follow-up
General Strategies
jenweiying
2018-01-30T16:37:10+08:00