Dr Sara Matley – Consultant Clinical Psychologist, LGI Dr Rachel Avison – Senior Clinical Psychologist, LGI

Introductions Dr Sara Matley Mrs Jayne Slack Senior Counsellor jayne.slack@nhs.net Dr Sara Matley Consultant Clinical Psychologist s.matley@nhs.net Dr Rachel Avison Senior Clinical Psychologist rachel.avison@nhs.net Dr Nadia Khurram Clinical Psychologist n.khurram-aziz@nhs.net Sandie Allison Counsellor Sandie.allison1@nhs.net

On a lighter note…

On a more professional note… 1. Everyone here will have: Delivered bad news Observed someone receiving bad news Experienced bad news first hand 2. Whether bad news is delivered or received, it can be a difficult and emotive experience for all 3. As a result, look after yourself. If you need to step out it’s fine to do so

Breaking bad news well Patient/ Carer Professional Influences… - Emotional health & adjustment - Physiological health (e.g. blood pressure, pain) Influences… - Emotional health (e.g. stress, burden, burn out) - Physiological health Patient/ Carer Professional

What helps? A structure Kaye’s 10 step approach - Kaye (1999) SPIKES model - Baile & Buckman (2000) ABCDE mnemonic - Rabow & McPhee (2000) Communication Preparation Planning Follow up

Prepare the patient/ family 1. Preparation Prepare yourself Prepare the setting Prepare the patient/ family

Prepare Yourself High anxiety normal Avoidance common Remember, the news may be very sad but having info allows patients/ families to plan & process Take time - review patient info & plan what to say More contained, better experience for all Take a colleague if possible

Prepare the setting Ensure protected time Privacy – a quiet room ideal, if not, make space ‘Do not disturb’ All sit down, no barriers between you Handover phones/ bleeps Tissues, water nearby

Prepare the patient/ family Is the patient/family ready to receive difficult news? Child present? Their Developmental level? Communication needs? Signer, interpreter, support worker Any religious, cultural, ethical views?

Prepare the patient/ family Before you tell, ask. What does the patient/ family know already? Denial, wishful thinking, unrealistic expectations? Obtain permission to have a conversation Share that difficult news is coming Start with the facts, minimal technical language Give the info in small sections Pause throughout to allow processing

2. Communication Rapport – eye contact, emotional warmth, summarise, ask questions, open, honest communication Look for cues Less sympathetic statements – ‘I’m sorry about this’ ‘I understand’ ‘I know this is very sad’ More empathic statements - ‘this will be very difficult news for you to hear’ ‘it’s a really tough situation’ ‘this is very sad’ Silence is important, no need to fill gaps, take time ‘Sit with’ rather than fix - hold back with advice. Reassurance can be unhelpful

3. Planning End the conversation with a summary Ask patient/ family what would help Then make recommendations/ suggestions about support Arrange a follow up conversation - very likely the patient/ family may not recall the details of the conversation (20%)

4. Follow up Debrief and reflect Document the conversation Work as a team in exploring support options, e.g. CNS contact, Psychology referral, Play Specialist input, Childrens Heart Surgery Fund Summarise the discussion and support plan in writing if required Supervision & mentoring

Psychological Continuum

Thank you for listening! Any questions, comments, thoughts?

References Baile W et al. (2000) SPIKES – a six-step protocol for delivering bad news: application to the patient with cancer, Oncologist, 5, pp. 302-311. Kaye P (1996) Breaking bad news: A 10 step approach, Northampton: EPL Rabow MW & McPhee SJ (1999) Beyond breaking bad news: How to help patients who suffer, Western Journal of Medicine, 171, pp. 260-263. Royal College of Nursing Guidance document (2013) Breaking bad news: Supporting parents when they are told of their child’s diagnosis. University Hospital of South Manchester - Sage & Thyme Training http://www.sageandthymetraining.org.uk/