Breaking bad news to cancer patients

Breaking Bad News
to Cancer Patients
Dr. Ahmed Al Ibraheemi

Communication
• From Latin commūnicāre, meaning
• Which Is the purposeful activity of information
exchange between two or more participants in
order to convey or receive the intended
meanings through a shared system of signs
and semiotic rules.
"to share“

Effective Communication Skills Enable
Health care provider :
• To Improve patients’ understanding of their
illnesses,
• To Improve patient adherence to treatment
regimens,
• To use time efficiently,
• To Avoid burnout, and increase professional
fulfillment.

Five Stars Health Care
Provider
Care GiverDecision MakerManager
Good
CommunicatorCommunity leader

Why Communication with cancer
patients is complex
Responding to patients’ emotional reactions
Dealing with the stress created by patients’ expectations for cure
The involvement of multiple family members
The dilemma of how to give hope when the situation is bleak.
Involving the patient in decision-making
Because it needs skills in

Bad news may be defined as :
“Any information which adversely and
seriously affects an individual’s view of his or
her future”

WHY BREAKING BAD NEWS IS
IMPORTANT?
• Oncologists give bad news thousands of times
during the course of a career and it can be highly
stressful.
• Breaking bad news to cancer patients is
inherently aversive, described as “hitting the
patient over the head” or “dropping a bomb”
• Breaking bad news can be particularly stressful
when the clinician is inexperienced, the patient is
young, or there are limited prospects for
successful treatment

PSYCHOLOGICAL REACTIONS TO BEING
GIVEN A CANCER DIAGNOSIS
Phase 1
•period of early reaction
Phase 2
•period of distress
Phase 3
•period of adaptation

Phase One
Period of early reaction
Within a few days
Temporarily deny the facts
Patients do not believe the information

Phase 2
Period of distress
After 1-2 weeks
Patients repeatedly develop symptoms such as,
Insomnia
Anxiety
Decreased
concentration.
Loss of appetite
Depression

Phase Three
Period of adaptation
After 2 weeks-I month, sometimes 3 months
Patients face reality and begin to or try to adapt
to the new situation.

WHAT ARE THE BARRIERS TO
BREAKING BAD NEWS?
ASCO survey identified several barriers to break bad news.
55% How to be honest with the
patientand not destroy hope
25% Cannot Deal with the patient’s
emotions
10% Not Find the right amount of time

Goals of the Bad News Interview
• Gathering information from the patient
First
• Provide intelligible information in accordance
with the patient’s needs and desiresSecond
• support the patient by employing skills to reduce
the emotional impact and isolation experienced by
the recipient of bad news.
Third
Forth develop a strategy in the form of a treatment plan
with the input and cooperation of the patient

A SIX-STEP STRATEGY FOR BREAKING BAD NEWS
Setup Perception
Invitation Knowledge
Empathize
Summarize and
strategize
SPIKES

S — SETTING UP the Interview
Arrange for some
privacy
Involve significant
others
Sit down
Make connection with
the patient
Manage time
constraints and
interruptions

P—ASSESSING THE PATIENT’S
PERCEPTION
Before you tell, ask
Uses open-ended questions

I—OBTAINING THE PATIENT’S
INVITATION
• While a majority of patients express a desire
for full information about their diagnosis,
prognosis, and details of their illness, some
patients do not.

K—GIVING KNOWLEDGE AND
INFORMATION TO THE PATIENT
Start at the level of comprehension and vocabulary of
the patient.
Try to use nontechnical words
Avoid excessive bluntness
Give information in small chunks and check periodically
as to the patient’s understanding.
When the prognosis is poor, avoid using phrases such as
“There is nothing more we can do for you.”

E—ADDRESSING THE PATIENT’S
EMOTIONS WITH EMPATHIC RESPONSES
An empathic response consists of four steps:
First
• Observe for
any emotion
on the part of
the patient
Second
• Identify the
emotion
experienced by
the patient by
naming it to
oneself.
Third
• Identify the
reason for the
emotion
Fourth
Let the patient
know that you
have connected
the emotion with
the reason for
the emotion by
making a
connecting
statement.

S—STRATEGY AND SUMMARY
Presenting treatment options to patients
Sharing responsibility for decision-
making with the patient
Checking the patient’s misunderstanding
of the discussion

Behaviours to Avoid
• Blocking occurs when a patient raises a
concern, but the physician either fails to
respond or redirects the conversation.
1. Blocking

Behaviours to Avoid
•‫االشع‬ ‫طبيب‬ ‫وابلغها‬ ‫القولون‬ ‫بسرطان‬ ‫مصابة‬ ‫مريضة‬‫ة‬
‫الكبد‬ ‫على‬ ‫للمرض‬ ‫انتشار‬ ‫بوجود‬
Role play

Behaviours to Avoid
• Lecturing occurs when a physician delivers a
large chunk of information without giving the
patient a chance to respond or ask questions.
2. Lecturing

Behaviours to Avoid
•‫طبي‬ ‫مع‬ ‫لها‬ ‫لقاء‬ ‫اول‬ ‫وهذا‬ ‫الثدي‬ ‫بسرطان‬ ‫مصابة‬ ‫مريضة‬‫بها‬
‫االمور‬ ‫بعض‬ ‫عن‬ ‫تستفهم‬ ‫ان‬ ‫وتحاول‬
Role play

Behaviours to Avoid
• Collusion occurs when patients hesitate to
bring up difficult topics and their physicians do
not ask them specifically—a “don’t ask, don’t
tell” situation.
3. Collusion

Behaviours to Avoid
•‫طبي‬ ‫مع‬ ‫لها‬ ‫لقاء‬ ‫اول‬ ‫وهذا‬ ‫الثدي‬ ‫بسرطان‬ ‫مصابة‬ ‫مريضة‬‫بها‬
‫الكالم‬ ‫قليلي‬ ‫الطرفين‬ ‫كال‬ ‫لكن‬
Role play

Behaviours to Avoid
• Premature reassurance occurs when a physician
responds to a patient concern with reassurance
before exploring and understanding the
concern.
Premature Reassurance

Behaviours to Avoid
•‫وال‬ ‫الرئة‬ ‫المنتشرعلى‬ ‫الثدي‬ ‫بسرطان‬ ‫مصابة‬ ‫مريضة‬‫كبد‬
‫حالت‬ ‫عن‬ ‫الطبيب‬ ‫وتسأل‬ ‫الدماغ‬ ‫على‬ ‫االنتشار‬ ‫واحتمال‬‫ها‬
‫جدا‬ ‫المتقدمة‬
Role play

Behaviours to Avoid
• Understanding the patient’s perspective will
result in physicians discovering more about
the thoughts and feelings patients are
experiencing.
Bad Respond to Emotion

Behaviours to Avoid
•‫ل‬ ‫يبالي‬ ‫وال‬ ‫متقدم‬ ‫وضعها‬ ‫بان‬ ‫الطبيب‬ ‫يخبرها‬ ‫مريضة‬‫حالتها‬
‫النفسية‬
Role play

Behaviours to Cultivate
• If you find that the conversation is going off
track, it is helpful to note that in your own
mind.
Tell Me More

Behaviours to Cultivate
• This principle is based on the notion that
education requires knowing what the learner
already knows, then building on that knowledge.
Ask–Tell–Ask

Breaking bad news to cancer patients

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Breaking bad news to cancer patients