1. Zagagazig university hospital
Tips for Breaking bad news A Critical clinical skill Prof.Mervat Atfy Mohamed

2. Learning objectives: After this session, you will:
*Recognize challenge to share bad news effectively
*Be able to describe an effectively six steps process to share bad news-SPIKES .Application to the Patient with Cancer
Be committed to improving your * skills in breaking bad news to patient 2

3. What is Bad news?
Any news that seriously and negatively alters the patient s view to her/his future 3

4. Goals *Help the patient and family understand the condition
*Support patient and Family
*Minimize risk of overwhelming distress 4

5. Why it is critical skill?
:*The physician perspective
high degree of difficult +
physician anxiety =
High risk of performing poorly.
When physicians are uncomfortable in giving bad news they may avoid discussing distressing information, such as a poor prognosis 5

6. Why it is critical skill?

7. What do patients want? For themselves *More time to talk
and show feelings
From Doctors
More information, caring.
Confidence ,hopefulness,
Familiar face 7

8. Six step Protocol For breaking bad Application to the Patient with Cancer news:

9. STEP 1: S :Setting up The interview
*Private setting, sitting down
*No telephone, turn off mobile ,no interruptions
*Ensure adequate time
*Review the condition ,lab, basic prognosis and treatment before visit
*Hopeful tone

10. STEP 2: P—ASSESSING THE PATIENT'S Perception
"before you tell, ask." *Assess the gap between what the patient knows and diagnosis. * What have been told about what are going on? *What is your understanding why the CT scan was ordered?
Mervat atfy mohamed

11. STEP 2: P—ASSESSING THE PATIENT'S Perception
Based on this information you can correct misinformation to patient

12. STEP 3: 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

13. STEP 4: K—GIVING KNOWLEDGE AND INFORMATION TO THE PATIENT
Warning the patient that bad news is coming may lessen the shock that can follow the disclosure of bad news and may facilitate information processing. Examples of phrases that can be used include,
"Unfortunately I've got some bad news to tell you“
or "I'm sorry to tell you that...".

14. STEP 4: K—GIVING KNOWLEDGE AND INFORMATION TO THE PATIENT
Try to use nontechnical words such as "spread" instead of "metastasized" and
"sample of tissue" instead of "biopsy."
Avoid excessive bluntness (e.g., "You have very bad cancer and unless you get treatment immediately you are going to die.") as it is likely to leave the patient isolated and later angry, with a tendency to blame the messenger of the bad news

15. Balanced truth and Hope :skillful use of indirect language
As ( it is look like) not (you have….. (There are tumours in the liver) not (you have tumor in your liver
when the prognosis is poor, avoid using phrases such as "There is nothing more we can do for you." This attitude is inconsistent with the fact that patients often have other important therapeutic goals such as good pain control and symptom relief 15

16. STEP 5: E—ADDRESSING THE PATIENT'S EMOTIONS WITH EMPATHIC RESPONSES
* Observe for and allow all emotional reaction
*Use touch
Name the feelings….. I know this is upsetting
……..it would be for any one Understanding

17. Respond to Empathically Emotions
Respecting…….you are asking all the
Right questions

18. STEP 6: S—Summary and strategy for follow up

19. Six step Protocol For breaking bad Application to the Patient with Cancer news:

20. At the end
The task of breaking bad news is testing ground for entire range of our professional skills. if we do it badly patients and family will never forgive us, if we do it well patients and their family never forget us

21. Your Business Company slogan in here
Thank You !