breaking bad news: an essential communication skill. 2017

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BREAKING BAD NEWS AN ESSENTIAL COMMUNICATIONS SKILL DR MOHAMAD AL-GAILANI CONSULTANT SURGEON BREAKING BAD NEWS COURSE 2017

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Page 1: Breaking Bad News: An Essential Communication Skill. 2017

B R E A K I N G B A D N E W SA N E S S E N T I A L C O M M U N I C A T I O N S S K I L L

D R M O H A M A D A L - G A I L A N IC O N S U LTA N T S U R G E O N

B R E A K I N G B A D N E W S C O U R S E

2 0 1 7

Page 2: Breaking Bad News: An Essential Communication Skill. 2017

BAD NEWS

•Any news that drastically and

negatively alters the patient’s view

of his or her futureBREAKING BAD NEWS COURSE DR. MOHAMAD AL-

GAILANI 20172

Page 3: Breaking Bad News: An Essential Communication Skill. 2017

EXAMPLES OF BAD NEWS

•Cancer diagnosis• Intra uterine foetal death• Life long illness e.g. Diabetes, epilepsy•Poor prognosis related to chronic diseases e.g. heart failure• Informing parents about their child’s serious mental/physical handicap•Non clinical situations like giving feedback to poorly performing trainees or colleagues

BREAKING BAD NEWS COURSE DR. MOHAMAD AL-GAILANI 2017

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Page 4: Breaking Bad News: An Essential Communication Skill. 2017

PATIENT’S AND FAMILY EXPECTATIONS

Privacy

Empathy

Dignity

Clarity of message

Competency

Time for questions

BREAKING BAD NEWS COURSE DR. MOHAMAD AL-GAILANI 2017

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Page 5: Breaking Bad News: An Essential Communication Skill. 2017

PATIENTS HAVE A RIGHT TO:

• Accurate and true information

• Receive or not receive bad news!

• Decide how much information they want or do not

want

• Decide who should be present during the

consultation, e.g. Family members

• Decide who should be informed about their diagnosis

and what information that person(s) should receiveBREAKING BAD NEWS COURSE DR. MOHAMAD AL-

GAILANI 20175

Page 6: Breaking Bad News: An Essential Communication Skill. 2017

RESPONSES TO BAD NEWS

• Denial

• Shock

• Anger

• Guilt

• Blame

• Agitation

• Helplessness

• Sense of unreality

• Misinterpreting

information

• Regret/anxiety

BREAKING BAD NEWS COURSE DR. MOHAMAD AL-GAILANI 2017

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Page 7: Breaking Bad News: An Essential Communication Skill. 2017

DO…

• Ensure privacy and

confidentiality

• Respect

• Honest

• Simple language

• Listen

• Sensitive to the non-

verbal language

• Allow for silence, tears

and other patient

reactions

• Document and liaise

with the

multidisciplinary teamBREAKING BAD NEWS COURSE DR. MOHAMAD AL-

GAILANI 20177

Page 8: Breaking Bad News: An Essential Communication Skill. 2017

DO NOT…

•Overload with

information

•Distort the truth

•Give false

reassurance

• Feel obliged to keep

talking all the time

•Withhold information

•Assume that you

know what is

concerning the

patient

•Criticize

•Make judgementsBREAKING BAD NEWS COURSE DR. MOHAMAD AL-

GAILANI 20178

Page 9: Breaking Bad News: An Essential Communication Skill. 2017

AVOID1. Meeting in public

2. Being alone

3. Hurrying!

4. Not being prepared!

5. Interrupted by your mobile phone!

6. Patronizing e.g. It is all your fault you smoked!

7. Give prognosis e.g. You have 6 months to live!

BREAKING BAD NEWS COURSE DR. MOHAMAD AL-GAILANI 2017

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Page 10: Breaking Bad News: An Essential Communication Skill. 2017

BREAKING BAD NEWS COURSE DR. MOHAMAD AL-GAILANI 2017

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Page 11: Breaking Bad News: An Essential Communication Skill. 2017

1. S: SETTING

Arrange for some privacy

Sit down

Make connection and establish rapport with

the patient

Manage time constraints and interruptions

BREAKING BAD NEWS COURSE DR. MOHAMAD AL-GAILANI 2017

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Page 12: Breaking Bad News: An Essential Communication Skill. 2017

2. P: PERCEPTION

Determine what the patient knows?

Listen to the patient!

Accept denial but do not confront at this

stage.

BREAKING BAD NEWS COURSE DR. MOHAMAD AL-GAILANI 2017

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Page 13: Breaking Bad News: An Essential Communication Skill. 2017

3. I: INVITATION

Ask patient if they wish to know?

Accept patient’s right not to know!

Offer to answer questions later if they wish

BREAKING BAD NEWS COURSE DR. MOHAMAD AL-GAILANI 2017

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Page 14: Breaking Bad News: An Essential Communication Skill. 2017

4. K: KNOWLEDGE

Use language appropriate to patient

Give information in small chunks

Give diagnosis e.g. Cancer

Give any positive aspects e.g. Cancer has not spread

Check whether the patient understood what you said!

BREAKING BAD NEWS COURSE DR. MOHAMAD AL-GAILANI 2017

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Page 15: Breaking Bad News: An Essential Communication Skill. 2017

5. E: EXPLORE

Prepare to give an empathetic response

Give the patient time to express their

feelings then respond

BREAKING BAD NEWS COURSE DR. MOHAMAD AL-GAILANI 2017

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Page 16: Breaking Bad News: An Essential Communication Skill. 2017

6. S: STRATEGY (SUMMARY)

Ask whether they want to clarify

something else?

Offer agenda for the next meeting e.g. I

will speak to you again when we have the

opinion of cancer specialist.

Close the interview

BREAKING BAD NEWS COURSE DR. MOHAMAD AL-GAILANI 2017

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Page 17: Breaking Bad News: An Essential Communication Skill. 2017

V I D E O

H O W N O T T O

B R E A K B A D N E W S

B R E A K I N G B A D N E W S C O U R S E 3 R D F E B R U A R Y 2 0 1 7 D R . M O H A M A D A L - G A I L A N I

Page 18: Breaking Bad News: An Essential Communication Skill. 2017

HOW NOT TO BREAK BAD NEWS

BREAKING BAD NEWS COURSE DR. MOHAMAD AL-GAILANI 2017

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Scenario: Relative informed (in public) by a junior doctor of the passing away of his father admitted to ER with a heart attack!

Page 19: Breaking Bad News: An Essential Communication Skill. 2017

VIDEO SCENARIO

•What went Wrong in this scenario?

1. Conducted in Public

2. Not given by the appropriate person

3. No Privacy

BREAKING BAD NEWS COURSE DR. MOHAMAD AL-GAILANI 2017

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Page 20: Breaking Bad News: An Essential Communication Skill. 2017

S C E N A R I O

NEW

BREAST CANCER

DIAGNOSIS( T h e c a s e o f M r s . A m a l )

BREAKING BAD NEWS COURSE DR. MOHAMAD AL-GAILANI

2017

Page 21: Breaking Bad News: An Essential Communication Skill. 2017

SCENARIO: (The case of Mrs. Amal)

•10 minutes (Scenario): The Consultation between Mrs. Amal and her surgeon Dr.

Lee.•10 minutes: Observer remarks.

•10 minutes: Course Participants’ remarks

•General Discussion & Questions.

BREAKING BAD NEWS COURSE DR. MOHAMAD AL-GAILANI 2017

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Page 22: Breaking Bad News: An Essential Communication Skill. 2017

SCENARIO: (The case of Mrs. Amal)

• Mrs. Amal is a 38-year-old housewife who presented with a 3-week history of feeling a lump in her right

breast.

• She has last week seen her surgeon Dr. Lee who after

examining her ordered investigations.

• The investigations included a mammogram,

ultrasound and a needle core biopsy from the lump

her right breast.

• She has come today for the Results of her

investigations. BREAKING BAD NEWS COURSE DR. MOHAMAD AL-

GAILANI 201722

Page 23: Breaking Bad News: An Essential Communication Skill. 2017

SCENARIO: 1. S: “Good afternoon Mrs. Amal”2. P: “What do you know so far Mrs. Amal”?3. I: “Would you like me to discuss your results”?4. K: “I’m afraid I have some bad news for you”, K “The test

results regrettably confirmed my fears…of breast cancer” 5. E: Checks the patient has understood the bad news E Let

patient ask questions and to discuss their concerns E Gives room to the patient’s feelings and silence.

6. S: “Can I summarize what we have discussed”, S “I will arrange for us to meet again next week”, S “Goodbye Mrs. Amal, see you next Monday with your husband”

BREAKING BAD NEWS COURSE DR. MOHAMAD AL-GAILANI 2017

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Page 24: Breaking Bad News: An Essential Communication Skill. 2017

OBSERVER COMMENTS:CASE OF MRS. AMAL

•What went well? Privacy, Eye Contact, No

Interruptions.

•Was it according to “SPIKES”? Yes

•Did Dr. Lee show Empathy, Knowledge,

Summate? Yes

•What could have been done better? Presence of

a Chaperon (Nurse), More Listening, Time for Silence!

BREAKING BAD NEWS COURSE DR. MOHAMAD AL-GAILANI 2017

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Page 25: Breaking Bad News: An Essential Communication Skill. 2017

BREAKING BAD NEWSSUMMARY

•A Difficult But Fundamentally Important Task for All Health Care Professionals.

•Focused Training in Communication Skills & Techniques Improves Performance.

•Enhances Patients’ Satisfaction & Physicians’ Comfort.

•An Essential Skill of Good Medical Practice.

BREAKING BAD NEWS COURSE DR. MOHAMAD AL-GAILANI 2017

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Page 26: Breaking Bad News: An Essential Communication Skill. 2017

D R . M O H A M A D A L - G A I L A N I F R C Sي ن ال ي ك ل ا د م ح م ر و ت ك د ل اC o n s u l t a n t S u r g e o n

ي ر ا ش ت س ا ح ا ر ج

M e d i c a l E d u c a t i o n & T r a i n i n g D i r e c t o rي ب ط ل ا ب ي ر د ت ل ا و م ي ل ع ت ل ا ل و ؤ س م

A l H a m m a d i H o s p i t a l , S u w a i d iي د ا م ح ل ا ى ف ش ت س ي, م د ي و س ل ا

R i y a d h , K S A

ض ا ي ر ل ة, ا ي د و ع س ل ا ة ي ب ر ع ل ا ة ك ل م م ل ا

T E L : 0 0 9 6 6 1 1 4 2 5 0 0 0 0

w w w . a l h a m m a d i . c o m