COMMUNICATING BAD NEWS: PATIENT AND FAMILY MEETINGS

OBJECTIVES Identify the components of delivering challenging news to patients and families. Utilize the Palliative Care Team for effective intervention. Identify the Family Meeting Process. Explain Intervention Techniques. List Barriers to Good Communication. Describe Keys to Effective Listening.

PRIOR PREPARATION Identify what is: The News. The Diagnosis. Treatment Plan. The Prognosis. What is the meaning to the Patient and Family.

IDENTIFY Who are the Family Members? Is there a Health Care Surrogate? How many Family Members are affected? What is the Patients first language? Is an Interpreter needed? Are there other support systems?

THE WORDS SERIOUS PROGRESSING ILLNESS, DETERIORATING CONDITION, OR YOUR CHILD IS CRITICALLY ILL, ARE ALWAYS VERY FRIGHTENING TO EITHER THE PATIENT OR FAMILY (OR BOTH).

UTILIZING THE EXPERTISE OF THE PALLIATIVE CARE TEAM CAN BE A BUFFER BEFORE, DURING AND AFTER THE NEWS.

PALLIATIVE EXPERTISE INCLUDES. Pain and symptom management. Psychosocial support. Spiritual support. Expert listening skills. Negotiating difficult situations. Offering as much time as the patient/family needs. Expertise in disease process, treatment and probable outcome. Coordinating and facilitating family meetings.

STARTING WELL Location of the meeting. Should be in a quiet place allowing privacy. Request cell phones are on vibrate. Have tissues available. Minimize interruptions. Encourage participants to feel at ease. Introduce team members by name and discipline. (cont.)

(cont) PC Team members listen non judgmentally and attentively. Encourage the patient and/or family to start where THEY wish to start. Share information. Give information in small amounts and allow time for it to be understood. Use easy to understand language, not medical jargon or acronyms. Check the patients and familys understanding frequently. At the first meeting only give as much information as they wish to hear.

BE PREPARED FOR REACTIONS AND RESPONSES INCLUDING: Tears, silence and anger. What did I do wrong? What did I neglect to do? Why me? Why us? How will I tell family and friends? I cant make decisions now. I refuse to believe there is no hope.

INTERVENTIONS Respond to the patient and/or family feelings, identify and validate reactions. Answer questions honestly. Give time to assimilate what is being said. Explore cultural needs. Identify religious and spiritual needs. Identify emotional and psychosocial needs. Remember most of us are not medically knowledgeable. (cont)

Help to identify immediate needs and interventions. Assist in developing short, medium and long range goals. Dont finish meeting until a level of comfort is achieved by patient and/or family. Follow up the next day, sooner if necessary. Provide a continuum of compassionate care. REVIEW, REASSESS, VALIDATE, REINFORCE.

BLOCKS TO UNDERSTANDING FOR FAMILY AND SOMETIMES STAFF INCLUDE: Language barriers causing incomprehension or misunderstanding. Inability to concentrate. Fear of what might be said. One person must get in the last word. Completing other peoples sentences. Identifying with the patient or family. (Cont.)

Cont) Giving too much information too quickly. Offering false assurances. Patient not wanting to be a bother to the Doctor. Being always right. Judgmental thinking over such matters as smoking, obesity, alcoholism, drug addictions, nationalities other than our own. Transfers to other units.

KEYS TO EFFECTIVE LISTENING The Listener is PRESENT, which means to: Sit with and facing toward the patient. Keep eye contact when culturally appropriate. Seek to understand before being understood. Help clarify issues. Accept what is being said. Not making judgments. Clarify ideas or feelings. Reflect these back to the participant(s). Receives feedback.

Bibliography Brixey, L (2004). The difficult task of delivering bad news. Dermatology nursing, 16(4), Dahlin, C.M., Giansuacusa D.A., Communication in Palliative Care Palliative Nursing ed: Ferrell, B., Coyle N. (2006) EPEC Project 2003 Robert Wood Johnson. Module 2: Communicating Bad News. Module 8: Sudden Illness. Woodruff, L & B. IN AN INSTANT (2007) Random House Publishing. NY