[01.15] FCM - Breaking Bad News V2.pdf

Any news that drastically and negatively alters the patient’s view of his or her future

What is the definition of bad news?

Death of a loved one, disability, impairment, or a poor prognosis

What are four forms of losses mentioned that constitute bad news?

Terminal or incurable illness

Besides death and dying, bad news is NOT confined only to what?

An applicant being turned down for a job

What is an example of non-medical bad news?

An athlete losing a limb

What is a specific example of bad news for a sports professional?

The patient’s perspective

What must always be remembered when determining what constitutes bad news?

The period or timing in which the person receives it

Besides the news itself, what factor can make news "bad" for a particular person?

The giver and the receiver

Bad news can be "bad" for which two parties involved in the disclosure?

Fear of hurting or upsetting the receiver

What is a primary factor that makes breaking bad news difficult for health professionals?

Doctors are trained to cure and make patients feel better

Why does the "fear of failing patients" make delivering bad news difficult?

Fear of being blamed

What type of fear involves the patient's potential negative reaction toward the doctor?

Anxieties over how the professional might respond

What causes internal stress for the clinician during disclosure?

Not knowing the answers to questions

What specific worry do health professionals have regarding patient queries?

Feeling inadequately prepared or trained

What is a common self-assessment of health professionals regarding their skill in breaking bad news?

If the patient starts crying or the family quarrels

What are two examples of patient/family reactions that health professionals may find uncertain to handle?

The attending physician

Technically, who should always be the one to break the bad news to a patient?

Emergency cases or accidents

In what special circumstances might a junior resident or nurse have to break bad news?

Empowerment for active decision-making

Why do patients have a right to information held by the clinician?

Moral, ethical, and legal

What are the three types of duties a physician has to inform a patient?

Collusion

What term refers to the family refraining from letting the patient know of their condition or diagnosis?

Belief that the patient's condition may worsen upon disclosure

What is a common reason families give for collusion?

A patient with a predisposition to depression

In what specific mental health context might a family fear that a terminal diagnosis would cause further harm?

Belief that the patient would not understand

Why might a family collude regarding a patient with learning disabilities?

Check the cost to the colluder

What should the physician assess regarding the family member who is keeping the secret?

Negotiate access to the patient

What should the doctor do to check the patient's actual understanding of the situation?

Promise not to give unwanted information

How can a clinician reassure a family that is hesitant to disclose a diagnosis?

Advanced preparation

What does the 'A' stand for in the ABCDE model?

Build a therapeutic environment/relationship

What does the 'B' stand for in the ABCDE model?

Communicate well

What does the 'C' stand for in the ABCDE model?

Deal with patient and family reactions

What does the 'D' stand for in the ABCDE model?

Encourage and validate emotions

What does the 'E' stand for in the ABCDE model?

Background

What does the 'B' stand for in the BREAKS protocol?

Rapport

What does the 'R' stand for in the BREAKS protocol?

Explore

What does the 'E' stand for in the BREAKS protocol?

Announce

What does the 'A' stand for in the BREAKS protocol?

Kindling

What does the 'K' stand for in the BREAKS protocol?

Summarize

What does the 'S' stand for in the BREAKS protocol?

Six

How many steps are in the SPIKES protocol?

Gathering information from the patient

What is the first objective of the SPIKES protocol?

Transmitting medical information

What is the second objective of the SPIKES protocol?

Providing support

What is the third objective of the SPIKES protocol?

Eliciting patient collaboration

What is the final objective of the SPIKES protocol?

Setting

What does the 'S' stand for in SPIKES?

Perception check

What does the 'P' stand for in SPIKES?

Invitation

What does the 'I' stand for in SPIKES?

Knowledge

What does the 'K' stand for in SPIKES?

Empathize

What does the 'E' stand for in SPIKES?

Summarize and Strategize

What does the second 'S' stand for in SPIKES?

Strategy, not a script

The SPIKES protocol is described as a what, rather than a what?

Physical space, tissues, and diagnostic information

What three things should a doctor be ready with during the "Setting" step?

Silent mode

In what mode should a doctor's phone be during the interview?

Privacy

What should a doctor arrange for to ensure a conducive environment for serious conversation?

Involve them only with the patient's consent

How should significant others be included in the interview?

Sit down

What physical action should a doctor take, if possible, during the interview?

Establish rapport

If a doctor has not seen the patient before, what must be done quickly during the "Setting" step?

Manage time constraints and minimize interruptions

What should a doctor do to maintain the focus of the interview?

Ask before you tell

What is the primary motto for the "Perception" step?

Determine what the patient knows or suspects

What is the goal of assessing patient perception?

Assess the gap

What should the doctor do regarding the difference between patient knowledge and the actual diagnosis?

Level of comprehension

To what should a doctor adjust their language during the perception check?

Accept denial

How should a doctor react if a patient is not ready to accept a diagnosis in the perception step?

Ask if they wish to know details

What is the physician obtaining during the "Invitation" step?

Right not to know

What patient right must be respected if they are not ready for details?

Reschedule

What should a doctor do if a patient wants to hear results with a family member who is not present?

Offer to answer questions later

If a patient declines information now, what should the doctor still offer?

Warning shot

In the "Knowledge" step, you should be direct and start with a what?

"Huwag po kayong mabibigla"

What specific phrase should be avoided because it shocks the patient?

"Mukhang hindi po maganda yung resulta"

What is an example of a direct warning shot phrase?

Educational level and socio-cultural background

What two factors should be considered when choosing language for the "Knowledge" step?

Gentle but not sugarcoated

What is the appropriate tone for giving knowledge to avoid misperception?

Scientific terms

What should a doctor NOT use if a patient may not understand them?

Small chunks

How should information be given to avoid overwhelming the patient?

Pathophysiology

What detailed medical process should you avoid overwhelming the patient with initially?

Observe nonverbal cues

How can a doctor check if a patient understood what was said?

Pause and allow minutes of silence

What should a doctor do if a patient needs to process information?

Positive aspects

What should you give first if survival rates or prognosis are good?

Facts about treatment options, prognosis, and costs

What three pieces of accurate data are valuable for the patient in the "Knowledge" step?

Observe and respond to emotions

What is the primary action in the "Empathy" step?

Space and silence

What should be respected if a patient needs to grieve?

Identify the emotion and its origin

What should a doctor do if the setting allows after delivering bad news?

Probing questions

What are used to validate feelings if an established relationship exists?

Comfortable

Validation of feelings is reserved for when the patient feels what?

Clarify something else

What should you ask the patient or family at the start of the "Summary and Strategize" step?

Agenda for the next meeting

What should a doctor offer regarding future procedures or information?

Referral to specialties and further tests

What should be included in a clear follow-up plan?

Written summary and brochures

What materials should be provided if the patient initially doesn't want to talk?

Community resources

To what should a doctor refer the patient for additional support?

Note of hope and partnership

How should every disclosure meeting end?

Document well

What is the first step a physician must take after disclosure?

Self-care

What must a doctor perform to assess their own reactions to the disclosure?

Peer group and consultant support

Where can a doctor find support if they relate too closely to a patient's story?

Denial, shock, anger, and guilt

What are four of the varying responses patients have to bad news?

Misinterpretation of information

What occurs when a patient is not ready for info and interprets it in a way favorable to them?

Ask or determine understanding

How should a doctor address potential misinterpretation?

Race, religion, and social background

What three cultural factors affect how a patient deals with bad news?

Never make assumptions

What is the rule regarding a patient's reaction to management in relation to cultural beliefs?

Age and ability to absorb

The difficulty of breaking bad news to a child depends on which two factors?

Team approach

What approach should the health team take when approaching a sick child?

Age-appropriate language and pace

In what manner should a child be told bad news?

What the child already knows

On what should a doctor build when disclosing to a child?