236 2021 u7 giving bad news SPIKES LIS

UNIT – LISTENING & SPEAKING (2 hours) ENGLISH IN MEDICINE – GENERAL PRACTITIONER Y2 GIVING BAD NEWS Presenter: Nguyen Hoang Quynh Mai Editor: Nguyen Hoang Quynh Mai Email: nguyenhquynhmai@duytan.edu.vn PRONUNCIATION EXERCISES LISTENING EXERCISES SPEAKING ACTIVITIES PRONUNCIATION EXERCISES mental/physical well-being cancer diagnosis life long illness mental/physical handicap poor prognosis sense of unreality misinterpreting information helplessness patient’s perception establish rapport time constraint body posture empathetic response express the feelings coping strategy PRONUNCIATION EXERCISES Breaking bad news is one of a physician's most difficult duties, yet medical education typically offers little formal preparation for this daunting task Without proper training, the discomfort and uncertainty associated with breaking bad news may lead physicians to emotionally disengage from patients Numerous study results show that patients generally desire frank and empathetic disclosure of a terminal diagnosis or other bad news Focused training in communication skills and techniques to facilitate breaking bad news has been demonstrated to improve patient satisfaction and physician comfort 1 PRONUNCIATION EXERCISES Physicians can build on the following simple mnemonic, ABCDE, to provide hope and healing to patients receiving bad news Advance preparation - arrange adequate time and privacy, confirm medical facts, review relevant clinical data, and emotionally prepare for the encounter Building a therapeutic relationship - identify patient preferences regarding the disclosure of bad news 1 PRONUNCIATION EXERCISES Communicating well - determine the patient's knowledge and understanding of the situation, proceed at the patient's pace, avoid medical jargon or euphemisms, allow for silence and tears, and answer questions Dealing with patient and family reactions - assess and respond to emotional reactions and empathize with the patient Encouraging/validating emotions - offer realistic hope based on the patient's goals and deal with your own needs 2 LISTENING EXERCISES VIDEO: https://www.youtube.com/watch?v=WYLbx0CK0YQ Listen to the video twice and try to fill in the blanks (since 04:41) LISTENING EXERCISES Mr Parker is an Olympic high jumper He (1) _ during training and it will (2) _ eight months to heal He is bringing training hard for the Commonwealth Games which are three months away You are his doctor and you must break the bad news of his ankle to him and explain that he will be (3) in the upcoming tournament 2 LISTENING EXERCISES ● Can I know (4) ? ● Do you got anybody that you’d like to have (5) ? ● I’m going to talk to you about your (6) that you had and unfortunately it’s quite a significant injury Do you mind if I talk it through in a bit of detail now? ● What you think (7) _ to your ankle? LISTENING EXERCISES ● Looking at the scans, looking at the history and the kind of the (8) , it looks as though you had quite significant injury ● Unfortunately and this is quite difficult news to convey given the nature of the injury itself and the degree of the break, it’s going to take a long time to heal up so there are other things that we have considered such as (9) or (10) 2 LISTENING EXERCISES ● We kind of racked our brains an thought about all the (11) _ that we would in this kind of scenario… I’m really sorry to have to (12) _ because it’s not going to be healed up within such a short space of time ● I think the main thing is to kind of be up front and let you know because I wouldn’t want you being unrealistic (13) how is my heal ● (14) at the moment? ● Well if you later on or if your family or your team want to discuss it in more detail then I’d be very happy to (15) _ so we can talk about it again in more detail 2 LISTENING EXERCISES Mr Parker is an Olympic high jumper He fractured his ankle during training and it will take at least eight months to heal He is bringing training hard for the Commonwealth Games which are three months away You are his doctor and you must break the bad news of his ankle to him and explain that he will be unable to perform in the upcoming tournament 2 LISTENING EXERCISES S 1/ Can I know why you’re here? S/I 2/ Do you got anybody that you’d like to have sitting in with you? I 3/ I’m going to talk to you about your ankle injury that you had and unfortunately it’s quite a significant injury Do you mind if I talk it through in a bit of detail now? P 4/ What you think might have happened to your ankle? LISTENING EXERCISES K 5/ Looking at the scans, looking at the history and the kind of the nature of the injury, it looks as though you had quite significant injury K 6/ Unfortunately and this is quite difficult news to convey given the nature of the injury itself and the degree of the break, it’s going to take a long time to heal up so there are other things that we have considered such as surgical intervention or physiotherapy 2 LISTENING EXERCISES E 7/ We kind of racked our brains an thought about all the standard things that we would in this kind of scenario… I’m really sorry to have to convey this news to you because it’s not going to be healed up within such a short space of time E 8/ I think the main thing is to kind of be up front and let you know because I wouldn’t want you being unrealistic in terms of how is my heal E 9/ Is there anything I can at the moment? S 10/ Well if you later on or if your family or your team want to discuss it in more detail then I’d be very happy to get in contact so we can talk about it again in more detail 3 SPEAKING ACTIVITIES ANSWER THE QUESTIONS 1/ What is bad news? Give some examples of bad news 2/ Why is breaking bad news difficult? 3/ What is non-verbal communication? 4/ What is SPIKES protocol? 5/ Name things the doctors should 6/ Name things the doctors should NOT 3 SPEAKING ACTIVITIES DESCRIBE THE PICTURE SPEAKING ACTIVITIES DESCRIBE THE PICTURE SPEAKING ACTIVITIES ROLE PLAY You are a junior doctor and you are on ward 201 at Da Nang Hospital You go to the senior doctor’s notes and find that your patient cannot take more than 10 units of insulin You have given 22 units You have already informed the patient but now need to speak to her daughter, Eliz 3 SPEAKING ACTIVITIES  Introduce name & role  Check consent  How much the situation you know so far?  You know that she’s a diabetic, don’t you?  I’m really very sorry to say that unfortunately there was a mistake with the prescription, the dose from the hospital  She’s currently stable, we are doing all that we can 3 SPEAKING ACTIVITIES  I don’t want to give you false answers, I don’t know exactly right now  We need to make sure this doesn’t happen again  This could be a serious incident, it’s going to be reported and then locked and it’s going to be investigated into exactly what, why, etc  I’m sure that you can whatever you need to  That is completely understandable  I think that anyone in your situation will react exactly the same way, so I don’t blame, I don’t take it personally, I understand 3 SPEAKING ACTIVITIES 1/ Listen actively – Use eye contact, verbal and non-verbal facilitation 2/ Be calm – stay composed and be open about the mistake 3/ Show empathy – Be apologetic, empathetic 4/ React well – React well to the patient’s emotion 5/ Come up with a solution – Ensure they are happy with how you are dealing with the mistake QUESTIONS & ANSWERS ... ANSWER THE QUESTIONS 1/ What is bad news? Give some examples of bad news 2/ Why is breaking bad news difficult? 3/ What is non-verbal communication? 4/ What is SPIKES protocol? 5/ Name things... empathetic disclosure of a terminal diagnosis or other bad news Focused training in communication skills and techniques to facilitate breaking bad news has been demonstrated to improve patient satisfaction... Encouraging/validating emotions - offer realistic hope based on the patient's goals and deal with your own needs 2 LISTENING EXERCISES VIDEO: https://www.youtube.com/watch?v=WYLbx0CK0YQ Listen to the video twice