Clinical communication with patients, relatives and care givers can be a challenge to healthcare providers. However, the use of communication skills and a therapeutic relationship may help seriously unwell patients and their families achieve the best way possible to cope with the illness (Finset 2015).
The first thing to be done whenever a clinical interview takes place or very important medical information is going to be disclosed to patients and/or family is planning and preparing the interview.
Breaking bad news is reported to be one of the most stressful communication tasks (Porensky et al. 2015), this is why preparation is so important, including where and how the information is going to be given and anticipating possible questions. Preparation includes preparing oneself, the patient/family and the environment (Barnett 2013).
Allowing enough time is key to enable successful communication. As the Regional Guidelines state “that it is strongly recommended that the person (named or specialist nurse) accompanying the professional who delivers the news, remains with the patient or family member if appropriate and help provide continuing support” (Department of Health, Social Services and Public Safety 2003).
Different strategies for managing difficult situations like the Ten-step approach, SPIKES (Box 1) and Seven-step approach have preparation as its first step (Lewis et al. 2010).
Use a “warning shot;” that is, say something to prepare such as, “I do not have good
news.”
Regional Guidelines state “that warning a patient or family member that bad news is coming may help lessen the shock and may help to process the information they receive” (DHSSPS 2003).
Social psychology research has suggested that this approach may be most effective in reducing shock and distress of news with potentially serious implications (Porensky et al 2015).
The news should be given in small chunks with pauses in between allowing time for information to be processed and encourage questions (DHSSPS 2003). Although the medical team will always try to make decisions in the best interest of the patient, the involvement of the patient and the family is decisive as the evidence suggests that patients increasingly want additional information regarding diagnosis, prognosis and treatment (DHSSPS 2003). It is important to remember the use of simple words and short sentences to ensure that the information provided is as clear as possible.
Patients and family often express feelings without talking about them (Egan 2013), their reactions and non-verbal communication can give us an idea of what the patient and family think and feel.
Planning and preparing includes establishing goals and objectives, select method of disclosure, select the content and arrange resources (Hargie 2010). Patients and family who have a clear plan for the future are less likely to feel anxious and uncertain (DHSSPS 2003). Furthermore, communication has a direct impact on the degree to which patients cope (Hawthorn 2015).
A study has shown that individuals who hear the negatively-framed prognosis are significantly more distressed than individuals who hear the positively-framed prognosis (Porensky et al 2015).
Breaking bad news is often a continuing process, it is important not to offer unrealistic hope but it is equally important that patients and family can discuss, consider options and come to terms with limitations without feeling abandoned by the health professional team (DHSSPS 2003).
Every person is different and the degree of information desired can vary as well as their expectations and their coping mechanism.
Evidence suggests that tailoring the amount of information provided according to the level of information a patient desire is associated with lower anxiety and better problem-focused coping (Porensky et al. 2015).
Breaking bad news can be extremely stressful for the professionals involved, emotions such as anxiety, a burden of responsibility for the news and fear of a negative response can have an adverse effect on those receiving and those delivering the news (DHSSPS 2003). Preparing the interview and following steps is a useful way of gaining confidence. Being clear about care goals may also assist staff who may need formal support in order to deliver high quality of care (Lewis et al. 2010).
Sources:
-Egan, G. (2013) The Skilled Helper. 10th Pacific Grove, California Belmont Brooks Cole/Cengage Learning.
-Hargie, O. (2010) Skilled interpersonal communication: Research, theory and practice. Hove Routledge.
-Porensky, E.K. and Carpenter, B.D. (2015) Breaking bad news: Effects of forecasting diagnosis and framing prognosis. Patient Education and Counseling, 99, 68-76.
-Lewis, D. and Kitchen, C. (2010) The role of communication skills in end-of-life care. Journal of renal nursing, 22(2), 69-74.
-Hawthorn, M. (2015) The importance of communication in sustaining hope at the end of life. British Journal of Nursing, 24(13), 702-705.
-Barnett, M. (2013) Breaking Bad News – Pointers and Pitfalls. Scottish Universities Medical Journal, 2(2), 54-57.
-Leonard, M., Graham, S., and Bonacum, D. (2004) The human factor: the critical importance of effective teamwork and communication in providing safe care. Qual Saf Health Care, 13(1), 85-90.
-Department of Health, Social Services and Public Safety. (2003) Breaking bad news Regional Guidelines. DHSSPS, Belfast.
-Finset, A. (2015) The elephant in the room: How can we improve the quality of clinical communication during the last phases in patients’ lives? . Patient Education and Counseling, 99, 1.
-http://www.ama-assn.org/ethic/epec/download/module_2.pdf
http://www.jpalliativecare.com/article.aspissn=09731075;year=2010;volume=16;issue=2;spage=61;epage=65;aulast=Narayanan
