Flashcards in Palliative Communication Seminar Deck (16)
What are the steps of the six-step protocol for breaking bad news?
1. Get the physical context right.
2. Find out how much the patient knows or suspects.
3. Find out how much the patient knows.
4. Share medical information.
5. Respond to the patient's feelings.
6. Plan and summarize.
What things fall under step 2 of the six-step protocol for breaking bad news, "Find out how much the patient knows or suspects"?
-The factual content of the patient's statements
-The style of the patient's statements
-Emotional content of the patient's statements
What things fall under step 4 of the six-step protocol for breaking bad news, "Share medical information"?
-Align (using patient's words and current knowledge)
-Give information in small amounts
-Use plan language (not medical jargon)
-Check that the message is being received, frequently
-Reinforce the information frequently
-Blend concerns and anxieties with those of the patient
What things fall under step 6 of the six-step protocol for breaking bad news, "Plan and summarize"?
-identify coping strategies of the patient and reinforce them
-identify sources of support for the patient
What are some barriers to good communication at the end of life?
Fear of one's own mortality.
Lack of personal experience with death and dying.
Fear of expression emotion, such as showing tears.
Unrealistic expectations for cure.
Fear of not knowing the answer to a question or whether to be honest when answering a question.
Disagreement with patient/family decisions.
Lack of knowledge/understanding of the patient's/family's culture.
Lack of knowledge/understanding of the patient's/family's end-of-life goals, wishes, and/or needs.
Unresolved personal grief issues, such as loss of one's own patients.
Ethical concerns, which may lead to disagreements between patients, family members, or health care providers related to care.
Professional insensitivity demonstrated by interrupting communication, patronizing, and not allowing patients/families to express their views.
Physical and emotional distance from the patient/family members, such as standing away and lack of eye contact.
What are 12 guidelines that can help nurses to break bad news with compassion?
1. Acknowledge your own feelings before you meet with your patient's family.
2. See yourself as calm.
3. Introduce yourself to your patient's family.
4. Take them to a private place where you can talk.
5. Offer chairs to everyone and invite them all to sit before you begin talking.
6. Explain first that you have some news about the patient's condition.
7. Speak slowly and pause after each sentence.
8. Tell them that the news is unpleasant and then pause before continuing.
9. Explain briefly what's happened to the patient.
10. Encourage family members to ask questions.
11. Offer support by staying with the family for a few minutes - unless you sense that they want to be alone.
12. If you're informing family members that their loved one has died, use the patient's name. Don't say "the body".
What is the rationale behind acknowledging your own feelings before breaking bad news to a family?
By doing this, you identify your feelings and reduce your anxiety level.
What is the rational for seeing yourself as calm before breaking bad news to a patient's family?
If you're too anxious, you won't focus well. For example, you may talk too fast, preventing effective communication. Think about what you'll say before you meet them family. For example, you might plan to say "I have some news to give you." (Pause.) "It's about your son." (Pause.) "The news is serious." (Pause.) "There's been an accident..."
How should you introduce yourself to a patient's family before breaking bad news?
Tell them your name, your position, and your relationship to the patient. As you do this, make solid eye contact and firmly shake hands with them - a handshake can convey warmth and caring.
What is the rationale for taking a patient's family to a private place before breaking bad news?
Privacy will encourage family members to more freely express their emotions.
What should you do instead of offering a chair if you're breaking bad news over the phone?
Make sure the listener is sitting down.
What is the rationale for speaking slowly and pausing after each sentence when breaking bad news to a patient's family?
Pausing frequently not only helps you slow down, it also supports your listeners' psychological defense system.
What is the rationale for pausing after you tell them that the news is unpleasant, and then continuing?
The pause is extremely important because family members will be in denial. By pausing, you'll allow their defense systems to kick in and provide protection at a vulnerable time.
When should you leave the room after breaking bad news to a family, and what should you do if you leave the room?
Stay with the family for a few minutes - unless you sense that they want to be alone.
Don't assume they want you to leave based on your own discomfort. If you leave the room, tell them where they can reach you and when you'll be back.
What is the rationale for using a patient's name when breaking bad news to a family?
Using the patient's name is another way to support the psychological defense system. Let family members know where the patient has been taken and, if possible, let them visit their loved one.