HOW TO COMMUNICATE BAD

NEWS EFFECTIVELY AND STAY

HUMAN AS A PROFESSIONAL JULIA SAMUEL

ALL TOGETHER BETTER HEALTH V111 OXFORD 6-9 SEPTEMBER

COMMUNICATING BAD NEWS EFFECTIVELY

AND STAYING HUMAN AS A PROFESSIONAL

Julia Samuel

Founder Patron

Child Bereavement UK

ALL TOGETHER BETTER HEALTH V111

OXFORD 6-9 SEPTEMBER

ATBH VIII

8th September 2016

WHEN MEDICINE FAILS

HUMANITY IS KEY

WHEN MEDICINE FAILS

IT IS OUR HUMANITY

THAT HAS TO REACH OUT

ATBH VIII

8th September 2016

IN WORKING WITH

GRIEVING FAMILIES

WE ALL BRING OUR OWN:

Beliefs and values

Hurts and losses

Feelings about death

Desire to care for others

Ability to reach out and be involved

Inability, when overpowered by the horror or

tragedy of death and our own emotions

WHY DID YOU CHOOSE TO DO THIS JOB?

ATBH VIII

8th September 2016

When bad news is delivered poorly the

experience may stay in a patient’s or family’s

mind long after the initial shock of the news has

been dealt with.

study;

Holland, JC. 1989

ATBH VIII

8th September 2016

LISTENING TO INDIVIDUAL

NEEDS OF THE FAMILY

Parents Say

“Parents are the ones who know their children best.

It is impossible for professionals to have the insight

necessary to help, if they don’t listen.”

“We adore our child, appreciate what he is capable of and

have acted in his best interests without worrying which

professionals we upset in the process. If they can’t see

the child instead of the label, it’s their problem, we’ll go

elsewhere.”

study;

Mencap: 2008

Contact A Family: 2009

ATBH VIII

8th September 2016

FAMILIES NEED:

Information

Guidance

Family support

To be themselves

study;

Murray Parkes. 2001

ATBH VIII

8th September 2016

HOW TO COMMUNICATE BAD NEWS?

PREPARE FOR THE DISCUSSION

Establish what the patient and family know

Determine how information is to be handled

Deliver the information

Respond to emotions

Establish goals for care and treatment priorities

Establish a plan

study;

Von Gunten et al: 2001

ATBH VIII

8th September 2016

PREPARATION

FOR THE

MOMENT OF

DEATH

study;

Vickio, C.J. 1999

ATBH VIII

8th September 2016

PARENTING

DOESN’T STOP...

“When I stood at the hospital door, it

was the hardest thing of all, to leave

him there, on his own. I felt as though

I was leaving him when he was

needing me most. I wondered if he

was lonely.”

THE POWER OF VULNERABILITY

ATBH VIII

8th September 2016

Underlying fear of self-disintegration

VULNERABLE INVULNERABLE TOTALLY

VULNERABLE

Potentially constructive and

helpful to patients &

ourselves

Underlying illusion of own

importance - strives to achieve

‘perfect death’,

‘knows’ all patients needs

The ‘perfect’ care provider

Relation with Others

Low permeability

High boundaries

Alienation from other

Relation with Self

Unaffected by experience

Unable to process loss and grief

Relation with Others

Displays empathy

Develops symbiotic relationship with

other Adapts/fails to adapt to needs of

others

Relation with Self

Accepts personal strengths and

limitations

Able to process impact of loss and

grief

The ‘good enough’ care provider

Relation with Others

High permeability

Low boundaries

Destructive identification with other

Relation with Self

Overwhelmed by experience

Unable to process loss and grief

The ‘ineffective’ care provider

ATBH VIII

8th September 2016

AUTONOMIC

NERVOUS SYSTEM:

Arousal response:

Sympathetic

Wind down response:

Parasympathetic

ATBH VIII

8th September 2016

AT WORK:

AIMS OF DEBRIEFING

Safe place to express feelings

Recognise and release emotions

built up during event

Mistakes part of learning process

Extends limited picture of what happened

during the event, while involved they only

observe those parts their position allows

them to

Identify resources, limits, strengths

study;

Gibbs, G: 1988

ATBH VIII

8th September 2016

Description what

happened?

What were your

feelings and how

did you react?

Initial evaluation

of the experience

what was good and

bad about it? Critical analysis

what sense did you

make of the

experience

Final evaluation

and action plan

what would you do

differently

Conclusion what

have you learnt from

reflecting on

this experience?

ATBH VIII

8th September 2016

Keystone Habits

Cue-Reward-Routine

Location /Time /Emotional State/ Other People /Pattern

Charles Duhigg

www.powerofhabit.com

THE POWER OF HABIT:

ATBH VIII

8th September 2016

THE POWER OF HABIT:

DON’T ASK YOURSELF THE QUESTION

J.F.D.I.

study;

Charles Duhigg: www.powerofhabit.com

ATBH VIII

8th September 2016

SELF CARE:

EXAMPLES OF STRATEGIES FOR SELF CARE:

11 STEPS

ATBH VIII

8th September 2016

SELF CARE:

EXAMPLES OF

STRATEGIES FOR SELF

CARE 1. Understanding our own emotions

2. Accept and recognise your need for support,

both practical and emotional

3. Be aware of what support is available to you – establish who

can provide this regular supervision support

4. Journal

5. Exercise

6. Relaxation

7. Clarity about boundaries of our role

– time management

8. Self Compassion

9. Nutrition

10. Ways to relax mind and body

11. Life outside work

ATBH VIII

8th September 2016

REFERENCES

BREAKING BAD NEWS EFFECTIVELY

AND STAYING HUMAN AS A DOCTOR

Aiming high for disabled children:

better support for families

Bluebond-Langner, M. (1989). Worlds of

dying children and their well

siblings. Death Studies,13 1-16.

Bluebond-Lngner , M. (1987) The Private

Worlds of Dying Children Princeton

Universiry Press

Dept. of Education & Skills and HM

treasury 2007

Breaking Bad News- Regional Guidelines:

Partnerships in Caring (2000) DHSSPS

February 2003

Buckman R. (1992) Breaking Bad News:

A Guide for Health Care Professionals.

Baltimore: Johns Hopkins University

Press.

Children with terminal conditions A guide

for donors and funders Valuing Shortlives-

New philanthropy Capital

Dent, A. & Stewart, A. (2004) Sudden

Death in Childhood: support for the

bereaved family Edinburgh:Butterworth

Heinemann

Doka. K.J.E.(1989) Disenfranchised

grief:recognizing hidden sorrow Lexington Books

Doka, K. (1996) Living with grief after sudden loss.

New York: Routledge.

Davis H (1991) Breaking Bad News. Practitioner

235: 522-526

Fallowfield L. (1993) Giving Sad and Bad News.

The Lancet. 341: 477-478

Gilbert, K. R. (1996). “We’ve had the same loss,

why don’t we have the same grief?” Loss and

differential grief in families. Death Studies, 20, 269-

283.

Hoy AM (1985) Breaking Bad News to Patients.

British Journal of Hospital Medicine. 34: 96-99.

Holland JC. (1989) Now We Tell - But How Well.

Journal of Clinical Oncology. 7:557-559

Kubler Ross, E 1974 Journal of Marital and Family

Therapy

Murray Parkes, C. 2001 Bereavement: Studies of

grief in adult life

Maguire P (1985) Barriers of Psychological Care to

the Dying. British Medical Journal 291:1711-1713

Prigerson HG, Vanderwerker LC,

Maciejewski PK. Complicated Grief as a

Mental Disorder: Inclusion in DSM.

Chapter 8 in Handbook of Bereavement

Research and Practice: 21st Century

Perspectives, Eds. Margaret Stroebe,

Robert Hansson, Henck Schut, and

Wolfgang Stroebe, American

Psychological Association Press, 2007

Tesser A, Rosen S, Tesser M. (1971) On

the Reluctance to Communicate

Undesirable Messages (the MUM effect) A

field study. Psychol Rep. 29: 651-654

Vickio, C.J. (1999). Together in spirit:

Keeping our relationships alive when

loved ones die. Death Studies, 23, 161-

175.

Von Gunten et al 2001, The Development

of Breaking bad news, best practice,

Nursing Times

What makes my family stronger –Contact

a Family

Worden, J.W. (2006). Children and

grief. New York: The Guilford Press

Gibbs, G: 1988

www.childbereavement.org.uk

ATBH VIII

8th September 2016

Action for Happiness

www.actionforhappiness.org

Ben Shahar, Tal 2011 Happier Learn

the Secrets to Daily Joy and Lasting

Fulfillment

BMA, May 2007 The Health of Doctors

– Evidence

British Psychological Society, 2008

Psychological Debriefing

Damasio, A, 1999 The Feeling of What

Happens:

Body, Emotion and the Making of

Consciousness Heinemann: London

Damasio, A 1999 The Feeling of What

Happens:Body Emotion and the

Making of Consciousness Harcourt

Brace

Dept. of Health 2005 When a Patient

Dies

Duhigg, C. (2014) The Power of Habit

Turtle Books

Gibbs 1998, Reflection Model

Kabat-Zinn, Jon 2012 Mindfulness for

Beginners: Reclaiming the Present

Moment-and Your Life Sounds True,

Colorado

Aiming high for disabled children:

better support for families

Bluebond-Langner, M. (1989). Worlds of dying children and their well siblings. Death

Studies,13 1-16.

Bluebond-Lngner , M. (1987) The Private Worlds of Dying Children Princeton Universiry

Press

Dept. of Education & Skills and HM treasury 2007

Breaking Bad News- Regional Guidelines: Partnerships in Caring (2000) DHSSPS

February 2003

Buckman R. (1992) Breaking Bad News: A Guide for Health Care Professionals.

Baltimore: Johns Hopkins University Press.

Children with terminal conditions A guide for donors and funders Valuing Shortlives-

New philanthropy Capital

Dent, A. & Stewart, A. (2004) Sudden Death in Childhood: support for the bereaved

family Edinburgh:Butterworth Heinemann

Kabat-Zinn, Jon 2001 Full Catastrophe

Living: How to cope with stress, pain

and illness using mindfulness

meditation Doubleday

Mind.org.uk The Mind Guide: Food

and Mood

Neff, K 2011 Self Compassion W.

Morrow publishers

Paediatric Society 2008: Standards for

Bereavement Care

Pennebaker, James W. (1997)

Opening Up: The Healing Power of

Expressing Emotion. NY: Guilford

Press.

Pennebaker, J.W. (2004)._ Writing to

Heal: A Guided Journal for Recovering

from Trauma and Emotional

Upheaval._ Oakland, CA: New

Harbinger Press.

www.hse.gov.uk/press/2007 Cost of

Workplace Stress and Strategies for

Prevention

REFERENCES

IMPACT OF BEREAVEMENT

ON THE PROFESSIONAL –

STRATEGIES FOR SELF CARE

ATBH VIII

8th September 2016

Action for Happiness

www.actionforhappiness.org

Ben Shahar, Tal 2011 Happier Learn

the Secrets to Daily Joy and Lasting

Fulfillment

BMA, May 2007 The Health of Doctors

– Evidence

British Psychological Society, 2008

Psychological Debriefing

Damasio, A, 1999 The Feeling of What

Happens:

Body, Emotion and the Making of

Consciousness Heinemann: London

Damasio, A 1999 The Feeling of What

Happens:Body Emotion and the

Making of Consciousness Harcourt

Brace

Dept. of Health 2005 When a Patient

Dies

Duhigg, C. (2014) The Power of Habit

Turtle Books

Gibbs 1998, Reflection Model

Kabat-Zinn, Jon 2012 Mindfulness for

Beginners: Reclaiming the Present

Moment-and Your Life Sounds True,

Colorado

Aiming high for disabled children:

better support for families

Bluebond-Langner, M. (1989). Worlds of dying children and their well siblings. Death

Studies,13 1-16.

Bluebond-Lngner , M. (1987) The Private Worlds of Dying Children Princeton Universiry

Press

Dept. of Education & Skills and HM treasury 2007

Breaking Bad News- Regional Guidelines: Partnerships in Caring (2000) DHSSPS

February 2003

Buckman R. (1992) Breaking Bad News: A Guide for Health Care Professionals.

Baltimore: Johns Hopkins University Press.

Children with terminal conditions A guide for donors and funders Valuing Shortlives-

New philanthropy Capital

Dent, A. & Stewart, A. (2004) Sudden Death in Childhood: support for the bereaved

family Edinburgh:Butterworth Heinemann

Kabat-Zinn, Jon 2001 Full Catastrophe

Living: How to cope with stress, pain

and illness using mindfulness

meditation Doubleday

Mind.org.uk The Mind Guide: Food

and Mood

Neff, K 2011 Self Compassion W.

Morrow publishers

Paediatric Society 2008: Standards for

Bereavement Care

Pennebaker, James W. (1997)

Opening Up: The Healing Power of

Expressing Emotion. NY: Guilford

Press.

Pennebaker, J.W. (2004)._ Writing to

Heal: A Guided Journal for Recovering

from Trauma and Emotional

Upheaval._ Oakland, CA: New

Harbinger Press.

www.hse.gov.uk/press/2007 Cost of

Workplace Stress and Strategies for

Prevention

REFERENCES

IMPACT OF BEREAVEMENT

ON THE PROFESSIONAL –

STRATEGIES FOR SELF CARE

Welcome to All Together Better Health Viii

6-9th September 2016