Integrating Patient- and Family-Centered Care Principles into a Simulation-Based Curriculum:...

Effective Patient Communication Module 2: Sharing Bad News

Module development supported by a grant from the Picker Institute / Gold Foundation 2010 Challenge Grant

Learning Objectives Define bad news Demonstrate use of the SPIKES model when

sharing bad news with the patient During the patient encounter, attend to the major

emotional components of sharing bad news, especially expressions of fear, anger, sadness, denial, and guilt

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Expected Outcomes Recognize challenges and supports to effectively

sharing bad news with the patient & family Demonstrate the SPIKES model communication

strategy when sharing bad news with the patient & family

Demonstrate empathy when sharing bad news with the patient

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The Task of Breaking Bad News “If we do it badly, the patients or family members may never forgive us; if we do it well, they may never forget us.”(Buckman, 1992)

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What is Bad News? Information that

negatively alters the patient’s view of the future

(Buckman, 1992)

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(Tissot, 1872)

Challenges

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(Siegmund, 2008)

Lack of: Guidelines Training Experience Good role models

Concerns of: The provider The patient & family

Supporting Patient & Provider Patient & Family are supported by:

Being included in conversations & planning Being treated as care partners

Provider is supported by: Training & Practicing good communication skills Learning ways to effectively cope with emotionally

charged issues Having another person available who knows the patient

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SPIKES Model: The Six Steps Setting Perception Invitation Knowledge Emotions Strategy & Summary

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Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. SPIKES-A Six-Step Protocol for Delivering Bad News: Application to the Patient with Cancer. The Oncologist, 5, 302-311; 2000. SPIKES mnemonic used with permission.

Setting the Environment Provide privacy Introduce self Determine who else should be present Ensure no interruptions Provide comfortable space Create welcoming environment

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Perception Prepare before

speaking Ask about patient’s

perception of what is going on

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(Renoir/ Bjoertvedt, 2010)

Invitation Ask questions to invite

the patient into conversation

Ask how much information the patient wants to hear

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(Pissarro, 1881)

Knowledge Deliver the message

Use plain language Be mindful of body language Get to the point Give information in small chunks Pause Wait for reaction

Use “teach back” to verify that message was received

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Emotions and Empathy Be prepared for patient’s and family’s emotional

response Anticipate fear, anger, sadness, denial, guilt Be mindful of your own response Comfort the patient

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Strategy and Summary Assess patient’s readiness for planning

Negotiate next steps Verify support structure Acknowledge & answer questions

Summarize plan Use “teach back” technique Follow-up

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Video

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©2009 –“Sharing Bad News” Henry Ford Health System Department of Medical Education Video clip used with permission.

Discussion of the Video How well did the doctor handle the situation?

What worked well? What could have been handled better?

Have you experienced a scene like the one shown? What was your role? Describe the encounter

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What’s Next?

Expectations Reminders

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(Mahmud, 2008)

Special Thanks Module Development supported by a grant from the Picker Institute/ Gold Foundation 2010 Challenge Grant ©2009 –“Sharing Bad News” Henry Ford Health System Department of Medical Education The DHMC Patient and Family Centered Care Department, and Chaplaincy

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References American Academy on Communication in Healthcare (AACH). Enhancing Communication Skills.

http://www.aachonline.org/?page=EnhanceCommSkills. Accessed October 20, 2010. Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. SPIKES-A Six-Step Protocol for Delivering Bad News:

Application to the Patient with Cancer. The Oncologist, 5, 302-311; 2000. Bjoertvedt. File: Auguste Renoir Conversation.JPG. National Museum Stockholm; 2008. Wikimedia Commons.

http://commons.wikimedia.org/wiki/File:Auguste_Renoir_Conversation.JPG. Accessed December 6, 2010. Boyle WE, Colacchio TA. Patient and Family Centered Care at Dartmouth-Hitchcock. [DVD]. Lebanon, NH: Dartmouth-

Hitchcock Media Services; 2010. Bub B. Communication Skills That Heal. United Kingdom: Radcliffe Publishing Ltd; 2006. Buckman R. How to Break Bad News: A Guide for Health Care Professionals. Baltimore, MD: The Johns Hopkins University

Press; 1992. Buckman R. Talking to Patients About Cancer. BMJ, 313, 699-700; 1996. Coulehan JH, Block MR. The Medical Interview, Mastering Skills for Clinical Practice. 5th ed. Philadelphia, PA: F.A. Davis

Company; 2006.

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File: James Tissot-Bad News.jpg. National Museum Cardiff; 1872. Wikimedia Commons. http://commons.wikimedia.org/wiki/File:James_Tissot_-_Bad_News.jpg. Accessed December 6, 2010. File:Pissarro Conversation.jpg. Tokyo: The National Museum of Western Art; 1881. Wikimedia Commons

http://commons.wikimedia.org/wiki/File:Pissarro_Conversation.jpg.. Accessed December 6, 2010. Frampton S, Guastello S, Brady C, Hale M, Horowitz S, Smith SB, Stone S. Patient-Centered Care Improvement Guide. Picker Institute; 2008. http://pickerinstitute.org/wp-content/uploads/2010/06/pcc_improvement_guide.pdf. Accessed October 29, 2010. Henry Ford Health System Department of Medical Education. Sharing Bad News. [DVD]. Detroit, MI: Henry Ford Health System; 2009. Lloyd M, Bor R. Communication Skills for Medicine. 3rd ed. London: Elsevier; 2009. Mahmud A. File: Serious Discussion image by Ashfaq.JPG. Dhaka University Institute of Fine Arts; 2008. Wikimedia Commons.

http://commons.wikimedia.org/wiki/File:Serious_Discussion_image_by_Ashfaq.JPG. Accessed December 6, 2010. Rider EA, Nawotniak RH, Smith G. A Practical Guide to Teaching and Assessing the ACGME Core Competencies. Marblehead, MA: HCPro, Inc; 2007. Siegmund W. File: Mount Rainier 5839.JPG. 2008. Wikimedia Commons. http://commons.wikimedia.org/wiki/File:Mount_Rainier_5839.JPG. Accessed December 6, 2010.

Weiss BD. (2007). Removing Barriers to Better, Safer Care, Health Literacy and Patient Safety: Help Patients Understand, Manual for Clinicians. 2nd ed. American Medical Association Foundation and American Medical Association. http://www.ama-assn.org/ama1/pub/upload/mm/367/healthlitclinicians.pdf. Accessed December 15, 2009.

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