Communication skill & Breaking Bad News

COMMUNICATION SKILL & BREAKING BAD NEWS

Mohammad Tanvir Islam

WHAT IS A COMMUNICATION?? “ the process of passing information and

understanding from one person to another it is essentially a bridge of meaning between the people by using the bridge a person can safely cross the river of miss understanding “

Keith Davis

7CS OF COMMUNICATION

1. Candid2. Clear3. Complete4. Concise 5. Concrete6. Correct 7. Courteous

BARRIER TO COMMUNICATION SKILL

TYPES OF BARRIERS Semantic barriers Physical barriers Organizational barriers Psychological barriers

SEMANTIC BARRIERS Different language Different context for words and

symbols Poor vocabulary

মুদ্রা দ�াষ = Coin Fault মুদ্রা দ�াষ = অঙ্গ ভঙ্গিঙ্গ

PHYSICAL BARRIERS

TYPES OF PHYSICAL BARRIER

1. Noise 2. Improper time 3. Distance 4. Inadequate or overload information

ORGANIZATIONAL BARRIERS Organizational barriers occurs in the

organization due to rules ,regulation and hierarchical relationship .

TYPES OF ORGANIZATIONAL BARRIERS

1. Rules and regulations2. Hierarchical relationship

PSYCHOLOGICAL BARRIERS

TYPES OF PSYCHOLOGICAL BARRIERS1. Selective perceptions2. Premature evaluation3. Poor listening 4. Attitude of superiors5. emotions

BREAKING BAD NEWS

“any information which adversely and seriously affects an individual's view of his or her future” 

What is a bad news??

WHAT ARE THE BAD NEWS?

Unfavourable diagnosis Irreversible, un-treatable, or non-

stoppable diseases (or side effects, or complications)

disease recurrencespread of diseaserevealing positive results of genetic tests StigmatizationLate (to treat) stage diseases End of life decisionsDeath

PATIENTS DESIRE Less than 10% patients do not want to know their

illness 90% want to know about their illness 30% want to know the exact name of their illness Almost 100% want to know the “chance of a cure”

WHY SHOULD WE CARE? Ethical Professional Human rights Legal

PRACTICAL APPROACHES TO BBN

SPIKES ABCDE BREAKSSetting and Listening SkillsPatient PerceptionInvitation to Give InformationKnowledgeExplore Emotions & EmpathizeStrategy and Summarize

A- Advance PreparationB- Build environment/ relationshipC- Communicate wellD- Deal with reactionsE- Encourage & validate emotions

B – Background R – Rapport E – Explore A – AnnounceK – KindlingS – Summarize

SP IKES

STEP 1: S—SETTING UP THE INTERVIEW

Arrange for some privacy Involve significant others (family, relatives) Sit down Make connection with the patient Manage time constrain & interruption

ARRANGE FOR PRIVACY

Click icon to add picture

Think 5 seconds before you comment!

INVOLVE SIGNIFICANT OTHERS

SIT DOWN WHILE YOU TALK

MAKE CONNECTION WITH THE PATIENT

STEP 2P- ASSESSING THE PATIENT’SPERCEPTION

The InterviewThe Interview

Open-ended questions to create a reasonably accurate picture of

“how the patient perceives the medical situation”

STEP 3: I—OBTAINING THE PATIENT’SINVITATION Would you like me to give you all the

information Offer to answer any questions they may

have in the future or To talk to a relative or friend

STEP 4: K— GIVING KNOWLEDGE ANDINFORMATION TO THE PATIENT

“Unfortunately I’ve got some bad news to tell you” or “I’m sorry to tell you that…”.

WARNING THE PATIENT THAT BAD NEWS IS COMING………

HOW TO GIVE INFORMATIONS Start at the level of comprehension and

vocabulary of the patient Try to use nontechnical words such as

“spread” instead of “metastasized” and “sample of tissue” instead of “biopsy”

Avoid excessive bluntness (e.g., “You have very bad cancer and unless you get treatment immediately you are going to die”)

Give information in small chunks and check periodically as to the patient’s understanding

When the prognosis is poor, avoid using phrases such as “There is nothing more we can do for you.”

STEP 5: E—ADDRESSING THE PATIENT’SEMOTIONS WITH EMPATHIC RESPONSESPatients’ emotional reactions may vary

from silence disbelief Crying denial, or anger

AN EMPATHICRESPONSE CONSISTS OF FOUR STEPS

1. Observe for any emotion on the part of the patient

2. Identify the emotion experienced by the patient by using open questions to query the patient as to what they are thinking or feeling

3. Identify the reason for the emotion 4. Let the patient know that you have

connected the emotion by making a connecting statement.

If the emotion does not diminish shortly, it is helpful to continue to make empathic responses until the patient becomes calm

STEP 6: S—STRATEGY AND SUMMARY Patients who have a clear plan for the

future are less likely to feel anxious and uncertain

Ask the patients if they are ready for such a discussion

Present treatment options Share treatment responsibility with

patient

SP IKES

S= Setting P=Perception I=Invitation K=Knowledge E= Empathic S= Strategy & Summery

BARRIER TO BBN

I don’t know how much I could communicate with you………………

But

Thank you for being a good listener

Thank you