236 1920 u7 giving bad news VOC

UNIT – VOCABULARY & READING (2 hours) ENGLISH IN MEDICINE – GENERAL PRACTITIONER Y2 GIVING BAD NEWS EDITOR: NGUYEN THI BICH TRAM Email: bichtramdn94@gmail.com DEFINE BAD NEWS What is bad news? Give some examples If you were the patient to receive the bad news, how you feel? DEFINE BAD NEWS • “Information likely to drastically alter a patient’s view of his or her future” • “…situations where there is either a feeling of no hope, a threat to one’s mental or physical well-being, a risk of upsetting an established lifestyle, or where the message given conveys fewer choices in his or her life…” DEFINE BAD NEWS EXAMPLES OF BAD NEWS Cancer diagnosis Intra uterine fetal death Life long illness Poor prognosis related to chronic diseases Informing parents about their child’s serious mental / physical handicap • Non clinical situations • • • • • DEFINE BAD NEWS PATIENT’S AND FAMILY EXPECTATIONS Ø Ø Ø Ø Ø Ø Privacy Empathy Dignity Clarity of message Competency Time for questions DEFINE BAD NEWS RESPONSES TO BAD NEWS •Denial •Shock •Anger •Guilt •Blame •Agitation •Helplessness •Sense of unreality •Misinterpreting information •Regret / anxiety DESCRIBE SPIKES PROTOCOL DESCRIBE SPIKES PROTOCOL I - Invitation ü Ask patient if they wish to know? ü Accept patient’s right not to know! ü Offer to answer questions later if they wish DESCRIBE SPIKES PROTOCOL K - Knowledge ü Use language appropriate to patient ü Give information in small chunks ü Give diagnosis ü Give any positive aspects ü Check whether the patient understood what you said! DESCRIBE SPIKES PROTOCOL E – Emotions and Empathy (Explore) üPrepare to give an empathetic response üGive the patient time to express their feelings then respond DESCRIBE SPIKES PROTOCOL S – Strategy and Summary • Make a Plan or Strategy and Explain it • Preparing for the worst and hoping for the best • Identify coping strategies of patient and reinforce them • Identify other sources of support for the patient and incorporate them • Invite questions; Tell them what happens next • When a patient has left: Check your own feelings Group Discussion Why is breaking bad news difficult? Trigger videos APPLY SPIKES PROTOCOL Scenario You’re very quiet, can I ask what’s going through your mind? Would you like me to discuss your results? I will arrange for us to meet again next week Good afternoon, Mrs Lan? The test results regrettably confirmed my fears … of breast cancer How are you feeling about hearing the news? Can I summarize what we have discussed? What you know so far Mrs Lan? I’m afraid I have some bad news for you 10 Goodbye Mrs Lan, see you next Monday with your husband APPLY SPIKES PROTOCOL P – Perception • “Could you tell me what’s happened so far?” • “What have you made of the illness so far?” • “Do you have any ideas as to what the problem might be?” • “Is there anything you have been worried about?” • “What did doctor A tell you when he sent you here?” APPLY SPIKES PROTOCOL I - Invitation •“You don’t want to be bothered with the details, you?” • “Would you like me to tell you the details of the diagnosis?” • “I have the result here today, would you like me to explain it to you now?” • “Would you prefer if a family member / friend is present?” APPLY SPIKES PROTOCOL K - Knowledge • “Well, the situation does appear to be more serious than that.” • “I’m afraid / unfortunately / I’m sorry to tell you it is a tumor.” • “As you know, we took a biopsy and, unfortunately, the results are not as we hoped.” PAUSE & WAIT • “Am I making sense?” • “This might be a bit bewildering, you follow roughly what I’m saying?” • “Could you just tell me the general drift of what I have been saying, to check I’ve explained it clearly?” APPLY SPIKES PROTOCOL E – Emotions and Empathy (Explore) • “I can see this news was a huge shock” PAUSE & WAIT • “You appear very anxious” PAUSE & WAIT • “So you’ve told me that your biggest worries are telling your children and losing your hair?” • “How are you feeling about hearing the news?” • “You’re very quiet, can I ask what’s going through your mind?” • “What’s upsetting you the most?" VIDEO: A GOOD EXAMPLE OF GIVING BAD NEWS TO THE PATIENT https://www.youtube.com/watch?v=_uOS7hfKkVI https://www.youtube.com/watch?v=tGxnBDi9Vy8 WRITING PRACTICE What is bad news? Answer the question using a definition or examples (3-5 sentences) What is SPIKES protocol? (3-5 sentences) What makes giving bad news so difficult? (define bad news & why it is difficult in at least paragraphs) REVIEW 10 MCQS ON KAHOOT QUESTIONS & ANSWERS ...1 DEFINE BAD NEWS What is bad news? Give some examples If you were the patient to receive the bad news, how you feel? DEFINE BAD NEWS • “Information likely to drastically... PRACTICE What is bad news? Answer the question using a definition or examples (3-5 sentences) What is SPIKES protocol? (3-5 sentences) What makes giving bad news so difficult? (define bad news & why... • • • • DEFINE BAD NEWS PATIENT’S AND FAMILY EXPECTATIONS Ø Ø Ø Ø Ø Ø Privacy Empathy Dignity Clarity of message Competency Time for questions DEFINE BAD NEWS RESPONSES TO BAD NEWS •Denial •Shock