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A Strategy For Tackling A Difficult Conversation. Ravindra Maharaj MBBS, MSc (Dermatology), MRCP, ABIM (Internal Medicine, Geriatrics, Hospice and Palliative Medicine.) A Plug For Palliative Care • We help with symptom management. • We deal with difficult conversations e.g. code status, dealing with bad news. • The family meeting is our “Surgery.” • Hospice is a subset of Palliative Care. • Palliative Care can be involved at any stage of serious illness. Existential Spiritual What is Palliative Care? Social Psychological Physical Does Good Communication Matter? • Medical professionals have spent a great deal of time and effort to learn “the jargon.” • Research has shown that good communication is essential to our functioning. Good Communication • • • • • • Improves pt’s adjustment to illness. Lessens pain/ physical symptoms. Increases adherence to treatment. Improves satisfaction with care. Improved job satisfaction by staff. Less stress and burnout. Poor Communication • Increased use of ineffectual treatments. • Higher risk of conflict. • Less adherence to treatment. Can Good Communication Be Learned? • YES! • Some people are born communicators but… • communication is a skill that can be learned and improved. Breaking Bad News “Hope is the power of being cheerful in circumstances we know to be desperate.” GK Chesterton (1874 - 1936) British Writer and Journalist. How Do We Approach This? • SPIKES • NURSE • Tools that help prevent the dreaded…. • “FOOT IN MOUTH SYNDROME !” S P I K E S How to Break Bad News: A Guide for Health Care Professionals by Robert Buckman Setting the Scene Understand their Perception Get an Invitation Warning Shot Share Your Knowledge Empathic Statements •NURSE –Naming –Understanding –Respecting/Praising –Supporting –Exploring I Wish Statements Summarize Strategize Other useful tips… Silence Sit Mind the Volume Match the patient Pace yourself Give info in “Bite sized” chunks. Check and recheck understanding. Be honest. Avoid Jargon. Negotiate the Agenda Don’t talk too much Breaking Bad News over the Telephone.. • Setting: “Are you driving?” • Invitation : “Can you talk on the telephone now?” • Pre-warning is a plus. Eliciting Concerns • F- Function: – How is this illness afftecting you/your family? • I- Ideas: – What do you think is causing this? • F- Feelings: – How are you coping with all of this? – How do you feel? • E: Expectations: – What worries you about the future? – What are your hopes? Tough Times Transitions in Care Goals Transitions Heroes Denial “Be careful with that family.” • Reach for the NURSE toolbox! • Usually the big obstacle to processing COGNITIVE data is an EMOTIONAL issue. • Do not expect to get any further until you address the emotional component. Don’t Forget Self Care! • Debrief with Team member. • If a conversation is not going as expected, get help! • Even with excellent communicators, there are the few individuals who may make decisions that we may not fully comprehend/ agree with. Questions? References • Back A,Arnold R: Mastering Communication with Seriously Ill Patients. Balancing Honesty with Empathy and Hope.Cambridge University Press.2009. • Emanuel LL,Librach SL: Palliative Care; Core Skills and Clinical Competencies.Saunders Elsevier. 2007 • Thanks to Dr Toby Campbell for selected PowerPoint slides. Thanks!