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Transcript
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!