Breaking bad news - OSCE PREP PDF

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Breaking bad news - SPIKE template...

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Breaking bad news

- Introduction o Wash hands and PPE o Introduce with name and role o Ask them to confirm name and DOB and ask how they will like to be addressed o Explain purpose - for example ‘I have been asked to discuss something with you about your recent investigations o Gain consent

- Active listening and rapport o Maintain eye contact o Be relaxed – uncrossed arms and legs and leaning forward o Keep nodding when patient talks o Don’t interrupt patient o Ask patient how they are when they come in o Ask if they want water SPIKES

- Setting o This discussion should take place in quiet and comfortable place o Make sure tissues available o Sit facing patient without desk in between o Turn off phones o Ask If the patient wants a family/friend present o If someone present ask if they want to be alone

- Perception o Discuss sequence of events leading up to event first o Assess patients emotional state o Ask about symptoms they’ve been experiencing since o Explain ‘ the reason why we did them tests was to have an explantion for the symptoms. Were you aware of the investigations and what they would show?’ o Find out what patient knows or is expecting o ‘symptoms can be due to infection or can be due to serious condition

- Invitation o Check if they want results today o ‘I have results here today would you like for me to explain today’

- Knowledge o Deliver information in small chunks so they have time to process o ‘as you know we did biopsy etc and the results was not as we hoped’ o Long pause o ‘im sorry to tell you but from the investigations it shows you have cancer’ o Make sure tone is respectful, slow and clear o Gave patient time to process

- Emotions o Recognise and respond to emotions with acceptance, empathy and concern o Don’t lie by giving false hope o If you don’t have enough info – tell them this and suggest referring them o ‘I can see this is not news that you expected, im so sorry’

- Strategy and summary o Make plan together to next meet them o Inform of next steps o Don’t rush patients decision o Check patient’s understanding of the news you’ve given them o Summarise main parts o ‘ in these circumstances it is hard to process information so I will repeat what o o o o

I have said’ Answer any questions Offer assistant Patient information leaflet Offer chaplain if needed or appropriate...