Breaking bad news. Carsten Braun OB-Gyn Gelsenkirchen - Germany
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1 Breaking bad news Carsten Braun OB-Gyn Gelsenkirchen - Germany
2 Objec:ves Deliver bad news in a compassionate and empathe:c manner Iden:fy barriers to properly presen:ng pa:ents with bad news Use the SPIKES protocol to minimize the shock to the pa:ent
3 What are the difficul:es? As doctors, part of our job is to confront the pa:ent with bad news (diagnosis of cancer, fetal malforma1on, fetal loss, etc). Regarding the consequences that such news will have for the pa:ent (shock, severe stress, life changes, etc), breaking bad news may stand in contrast to our usual work of helping and suppor:ng the pa:ent.
4 What are the difficul:es? OQen doctors themselves feel extremely stressed, helpless and overburdened in having to do so but it is inevitable and part of our duty. The pa:ent benefits if in this acute situa:on the doctor acts emo:onally competent and is able to help the pa:ent to cope with her emo:onal reac:on. The aim is to legi:mize the emo:onal escala:on of the pa:ent.
5 What are the difficul:es? The emo:onal escala:on of the pa:ent (feeling that the whole world is breaking apart, that death is around the corner) may be worse if such news is given without warning in an unprotected environment. This oqen happens because of the stress and lack of :me that physicians experience in the clinical situa:on, and the lack of doctors apprecia:on for the trauma:c effects of such news.
6 The SPIKES Protocol Receiving bad news always leads to some sort of shock for pa:ents. To ensure that delivering the news will not aggravate the shock, the six steps of the SPIKES Protocol have been developed.
7 The SPIKES Protocol SeXng up the interview protected sexng, enough :me, perhaps company of a friend or rela:ve of the pa:ent
8 The SPIKES Protocol Assessing the pa:ent s percep:on what does the pa:ent know/an:cipate about her situa:on What do you think today s talk might be about? What do you think the results we are going to talk about will show?
9 The SPIKES Protocol Obtaining the pa:ent s invita:on trying to assess the pa:ent s preparedness to receive bad news Do you want me to tell you all the details or do you just want to hear the most important results? Do you want to speak about your results and their consequences now or later?
10 The SPIKES Protocol Giving knowledge and informa:on to the pa:ent delivering the bad news aqer a warning with genuine regret Unfortunately I have bad news for you. I am very sorry that I have to inform you about the following diagnosis which I found.
11 The SPIKES Protocol Addressing the pa:ent s emo:ons with empathy being suppor:ve for the pa:ent, trying to understand and to name the emo:ons of the pa:ent, giving room for the pa:ent to express her emo:ons
12 The SPIKES-Protocol Strategy and summary discussing the plan of ac:on, while always keeping in mind the emo:onal experience of the pa:ent. Trying to find an appropriate ending of the interac:on regarding the wishes of the pa:ent.
13 When SPIKES cannot be used SeXngs in which bad outcomes are iden:fied when the pa:ent is present (e.g. fetal demise, abnormal ultrasound findings)
14 When SPIKES cannot be used be aware of your body language (the pa:ent will always observe you very closely while you are doing your examina:on) try to keep an eye on the pa:ents reac:on if you discover an irrita:on tell the pa:ent that you no:ced her/his reac:on and that you will shortly tell her/him what you have found
15 When SPIKES cannot be used KISS: keep it short and simple use short sentences to give knowledge about the circumstance that you have found an abnormality use simple language try to keep calm and confident
16 When SPIKES cannot be used Tell the pa:ent that you will briefly end the examina:on and that you will discuss all the results immediatly aqerwards in a sound sexng! at this point you can return to SPIKES
17 Conclusions Bad news is inevitably shocking and upsexng for the pa:ent The shock and stress can be minimized by discussing the news in a caring and empathe:c manner, and allowing adequate :me for the pa:ent to voice her emo:ons The SPIKES protocol is a useful tool to help deliver bad news in a compassionate manner
18 References: A. Rhode, A. Dorn Gynäkologische Psychosoma:k und Gynäkopsychiatrie Schaaauer 2007 Baile et al., A six-step protocol for delivering bad news: applica:on to the pa:ent with cancer, Oncologist 2000; 5: Fallowfield L, Jenkins V. Communica:ng sad, bad, and difficult news in medicine. Lancet 2004; 363 (9405): Greiner AL, Conklin J. Breaking bad news to a pregnant woman with a fetal abnormality on ultrasound. Obstet Gynecol Surv 2015; 70(1):
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