Breaking Bad News

1. Breaking Bad News KHALED FAHAD ALKETHIRI 433103220 TARIQ KHALID ALMATRUDI 433100521 SULIMAN ALAA AL-BATNIJI 431101485

2. Objectives • Brainstorming stations. • Definition of bad news and its importance. • Methods and advices about breaking bad news. • Role of primary care physicians. • Example of how to break bad news and scenario for discussion • Hadeeth Shareef. • References.

3. Brainstorming station1-2 An angry daughter of a patient with non-curable cancer tries to talk to you regarding her father’s cancer. What would you do? A-Tell the nurse to tell the daughter that you are busy and can not talk to her. B-Tell the daughter everything about your patient condition. C-Tell the daughter that her father’s cancer can be cured easily. D-Let the daughter talk and explain why she's angry.

4. Brainstorming station2-2 When you were telling a mother that her son has a polycystic kidney disease, she started crying. What is the most appropriate next step? Tell her that her son will be okay to give her hope. Leave her and just give her time. Be empathetic. Ask the mother to stop crying.

5. Definition of bad news Bad news is “any information that produces a negative alteration to a person’s expectations about their present and future” (Fallowfield, Lancet, 2004).

6. Importance of breaking bad news 1-Recent Literatures demonstrated that patients prefer to know frankly about their health status. 2-Increases the patient-physician trust. 3-Enabling the patients to make an important life decisions and giving them the opportunity to discuss it with their own families. 4-Patient satisfaction on the healthcare provided.

7. Methods and advices for breaking bad news We will discuss the two most common used methods: 1-ABCDE approach. 2-SPIKES approach.

8. ABCDE’s of Delivering Bad News Advanced Preparation : -What does the patient already know/understand already?. -Prepare yourself emotionally. Build a therapeutic environment/relationship: -Arrange a private, quiet place without interruptions. -Provide adequate seating for all. -Sit close enough to touch if appropriate.

9. ABCDE’s of Delivering Bad News • Communicate Well: • -Be direct - "I am sorry that I have bad news for you.“. • -Limit the use of words such as– "Cancer," "AIDS," "Death" as much as possible at first. • -Allow for silence. • -Use touch appropriately.

10. ABCDE’s of Delivering Bad News • Deal with the reactions of the patient and family: • - Assess patient reaction: physiologic responses, cognitive coping strategies, and effective responses. • - Listen actively, explore, and show empathy. • Encourage and validate emotions, Evaluate the News: • - Address further needs: What are the patient’s immediate and near-term plans, social, emotional and financial needs that maybe necessary. • - Make appropriate referrals for more support. • Express your own feelings and DO NOT overreact.

11. SPIKES approach -Setting up the interview. -Perception of the patient towards their illness. -Invitation from patient to share information. -Emotions responded to empathically. -Summary and Strategy for follow-up.

12. SPIKES- SETTING UP the Interview -Arrange for some privacy. -Sit down, make sure that both of you are comfortable. -Avoid barriers. -Maintain eye contact.

13. SPIKES-Assessing the Patient's PERCEPTION • - Before you tell, ask for instance what do they think that they have. • You need to know what does the patient know about their health status so far. • What does the patient really need to know as a PATIENT. Avoid any unnecessary explanations.

14. SPIKES- Obtaining the Patient's INVITATION Check if the patient: - Wants to know The result now. - Would like a family member to be present. - Respect patient’s right if they do not want to know.

15. SPIKES- Giving KNOWLEDGE and Information to the Patient • - Use language intelligible to the patient. • - Consider educational level, socio-cultural background, current emotional state. • - Give information in small chunks. • - Check whether the patient understood what you said.

16. SPIKES -Addressing the Patient's EMOTIONS with Empathic Responses - Respond to Emotions empathically. - Observe for and allow emotional reactions. - Use of touch. - Name the feeling they may have “I know this is upsetting”. - Show understanding “It would be for anyone”. - Show respect “You’re asking all the right questions”. - Offer support “I’ll do everything I can to help you through this.”.

17. SPIKES- Strategy and Summary - Close the interview. - Ask whether they want to clarify something else. - Offer agenda for the next meeting.

18. Advices while breaking bad news -Reassure about pain, suffering, abandonment and consider patient’s feeling. -Do not use euphemisms, jargon, acronyms and use common understandable phrases. -Explore what the news mean to the patient and this will require you to know all details about the patient. -you may predict the reaction you may face from the patient and respond promptly.

19. Burden of bad news • On the physician: 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, stress and uncertainty associated with breaking bad news may lead physicians to emotionally disengage from patients. • On the patient: may cause socio-economic, psychological and physical problems and may lead the patient to lose hope. Patient also may harsh treatment. • On health care quality: Patients’ losing trust, thinking that the physician does not do his duty well. • - Loss of satisfaction on the healthcare provided.

20. What is primary care Primary care is the day-to-day healthcare given by a health care providers. Typically this provider acts as the first contact and principal point of continuing care for patients within a healthcare system, and coordinates other specialist care that the patient may need. Who is the primary care physician: A primary care physician is a specialist in Family Medicine, who provides definitive care to the undifferentiated patients at the point of first contact, and takes continuing responsibility for providing the patients with comprehensive care.

21. Role of family physicians in the breaking bad news - Breaking bad news to the patient and discussing all aspects of their condition including; diagnoses, course of disease and options of treatment. - Discuss the advantages and disadvantages of experimental treatment , discuss palliative care options such as hospice. - Aiming towards improving quality of life. - After referring the patient to a subspecialist, request patient schedule follow-up visits; ask the subspecialist to update you on the patient's care.

22. SCENARIO

23. Scenario 1-1 for discussion Mr.L came to your clinic for follow up. In his previous visit, he complained that he had lost significant weight and is experiencing abdominal pain. After investigations, he has been diagnosed with pancreatic cancer that has spread to the liver. His prognosis is poor. 5 year survival rate is 15%. Break this news to the patient.

24. HadeethShareef قوله - صلَّى الله عليه وسلَّم وفي الحديث: ((إنَّ عِظَم الجزاء مع عظم البَلاء، وإنَّ الله تعالى إذا أحبَّ قومًا ابتلاهم، فمن رَضِي فله الرِّضا، ومن سَخِط فله السُّخط))[1].

25. References https://library.islamweb.net/Newlibrary/display_book.php?flag=1&bk_no=79&ID=3140 http://www.cetl.org.uk/learning/feedback_opportunities/data/downloads/breaking_bad_news.pdf http://www.journeyofhearts.org/kirstimd/AMSA/abcde.htm https://depts.washington.edu/bioethx/topics/truth.html http://theoncologist.alphamedpress.org/content/5/4/302.full http://www.aafp.org/afp/2001/1215/p1975.html https://palliative.stanford.edu/communication-breaking-bad-news/defining-bad-new/

26. Any Questions!

27. THANK YOU SO MUCH FOR YOUR ATTENTION