Communication Skills: Breaking Bad News and Informed Consent

Principles of Communicating bad news:

Environment, Opening, Non-verbal communication, Tone of voice, Warning shot, Empathy, Silence, Dealing with emotions, Responding to owner, Conclusion

Additional considerations to consider when breaking bad news

Cultural competence, Diversity of thought, Financial position, Personal circumstances

What does the SPIKES protocol remind you to keep in mind when breaking news?

Setting, perception (from client perspective), invitation (does client want information you need/want to share?), knowledge (information that needs to be imparted onto the client), emotions (empathy levels will vary for different clients), strategy and summary (time may be needed to understand/digest information)

What does the PEWTER study remind you to keep in mind when breaking news?

Telling, prepare, warning, evaluate, emotional response, regrouping

What is key when dealing with emotion?

Empathy and active listening

What must you identify when helping someone deal with emotion?

The emotion the client is experiencing and the source of that emotion

Empathetic and compassionate responses link

Emotion to the source

What are some examples of empathetic statements?

I can see how upsetting this is to you, I know this is not good news for you, I was also hoping for a better result.

What are some examples of exploratory questions?

How do you mean, Could you explain what you mean, Could you tell me what you’re worried about

What are some examples of validating responses?

I can understand how you feel that way, it appears that you’ve thought things through very well, many other patients have had a similar experience

Breaking bad news is a pivotal skill in veterinary practice:

Do it well, your client will never forget; Do it badly, your client will never forgive

Informed consent is required in all cases when

A client requests that you treat an animal

When is informed consent not required?

A delay in treatment would adversely affect the animal’s welfare

Animal is wildlife and therefore no owner

To be considered informed consent, detailed communication with your client should cover, at least,

Range of reasonable treatment options, Associated risks, Fees, Preparing for deviations from the plan, Clarifications, Ensure clients have sufficient time to ask questions and make decisions

Signed consent forms are to add

Aid to consent process

When are signed consent forms used?

Admission/treatment/anesthesia/surgery, Euthanasia

For non-urgent procedures, the consent discussion should take place

In advance of the day of the treatment/procedure

Who can obtain informed consent?

Vet Tech/Assistant

Vet nurse

Veterinary surgeon

Typically, who is responsible for discussing matters with the client and obtaining client’s informed consent?

Treating veterinary surgeon

When the treating veterinary surgeon is not available, who is the most suitable person to delegate responsibility to?

Another veterinary surgeon

When the veterinary surgeons are not available, who is the next most suitable person to delegate responsibility to for obtaining informed consent?

Registered veterinary nurse or student veterinary nurse

Who can give informed consent?

Owner of an animal, Someone acting with authority of the owner (ie family member), Someone with statutory authority (police), someone with other appropriate authority (ie power of attorney)