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Day17SC.pdf

Patient-Provider: Discussing Bad News &

End of Life Communication

Day 1 7

Agenda PPC-Discussing Bad News & End

of Life Communication

Activity

Homework

Provider Skills for (PCC)

Active listening Therapeutic interviewing Advice giving Empathy Bad news delivery

1. 2. 3. 4. 5.

Bad News Delivery as the process of health care providers presenting unfavorable medical information or

diagnoses to patients and/or their families that likely is unwelcome or disturbing

patients or patients' families should not be given false hope, but instead must be presented

with accurate and truthful information

(Mattson & Hall, 2011)

Setting the environment of the health communication exchange and creating a

maximally conducive situation for the delivery of bad news

location of conversation is important to consider

quiet location

eye-level should not appeared rushed

block out potential interruptions

sustained eye contact & touching arm

(Mattson & Hall, 2011)

Perceptions of Health Status

determining perceptions of

health status allows health care

providers to correct any false

information and provide needed

explanations

reveal patients' and/or their

families' technical knowledge

of their health situation as

well as their emotional

condition

(Mattson & Hall, 2011)

feelings about the state of an individual's own health or the health of another

providers talk with patients and/or families about how much

information and in how much detail they would like to know about

their health and by what means they would prefer to receive that

information

respects that patients and their families are unique and

have different informational needs and desires

Invitation

(Mattson & Hall, 2011)

Knowledge

consider medical knowledge of

recipients

provide information in small chunks check of level of understanding

and emotional state

when the bad news is told to patients and/or their families

can provide a warning "I am sorry to have to tell you..."

"Unfortunately..."

avoid being excessively blunt

"You have cancer and have weeks to live" (Mattson & Hall, 2011)

Providers must be aware of patients' and/or families

emotional responses whether overt (crying) or more

introverted (silence)

Providers need to name or identify the emotions expressed to

themselves. If unsure, ask patients/their families

Providers should identify reasons for the emotions

"My patient is scared because the radiation did not shrink the tumor"

Providers should voice an empathetic response that names

and validates patients' and/or their families' emotions

"I understand that you are feeling frightened because of the poor

test results"

1.

2.

3.

a.

4.

a.

Emotions/Empathy

Four-Step Technique for Responding to Emotions and

Providing an Empathetic Response

address and respond to patients' and/or their families' emotions

while expressing empathy

(Mattson & Hall, 2011)

Summary provide a summary of the information provided & present a

strategy for future treatment

focus on creating a mutual plan for

making the patients and/or families

as comfortable and contented as

possible

focus on creating a mutual plan for

making the patients and/or families

as comfortable and contented as

possible

(Mattson & Hall, 2011)

Key Points from Brandt (2013)

"However, sometimes when patients ask a direct question, they're less sure they want a direct answer. So one of the things I try to do is make sure the patient actually wants the information he or she is asking for, and whether the timing and setting are correct. Often when probed, patients are not ready to hear difficult information, or they might need some time or a loved one present."

(Brandt, 2013, para. 5)

(Dr. Kavitha Jennifer Ramchandran)

"Ask permission. Patients can tell me whether they're ready to receive certain information." "Establish a comfortable setting. No one can talk when they are in pain or uncomfortable." "Make sure the right players are in the room. Some patients can't make a decision without their partner, a parent, or a child present." "If patients don't want information, find out who they want us to communicate with. Establish a surrogate decision- maker."

1.

2.

3.

4.

(Brandt, 2013, para. 7)

(Dr. Kavitha Jennifer Ramchandran)

"I usually provide a care map or plan with clear lefts and rights. I let people know that I have a certain number of tools in my toolbox but at some point, those tools will no longer be effective and the disease will become more difficult to control. I try to focus on the "disease" rather than the "fight" because basically even with all of our best efforts, some of these diseases are not curable. This isn't the fault of the patient or the physician."

(Brandt, 2013, para. 11)

(Dr. Kavitha Jennifer Ramchandran)

"Absolutely. Their journey is just beginning, while their loved ones' journey is ending. It's a different path and struggle. The same questions and rules apply around information giving, kindness, and making a plan."

(Brandt, 2013, para. 14)

(Dr. Kavitha Jennifer Ramchandran)

"

(Brandt, 2013, para. 19-20)

"Be humble. We're not in their shoes. Be kind. Do unto others as you would want done to you. Listen carefully. A hug is okay in the right setting. It's okay to cry at times... Cancer sucks."

"At the end of the day, find the things that keep you whole and happy... It will let you do all the right things again the next day."

(Dr. Kavitha Jennifer Ramchandran)

(Dr. Kavitha Jennifer Ramchandran)

KEY POINTS FROM NGO-METZGER ET

AL. (2008)

Li et al. (2020) Malhotra et al. (2020) RA 10 Due by 11:59 pm ET Podcast