L-19 Truth Telling & breaking bad news (BBN) (Prof.faisal)
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Lecture on truth telling and breaking bad news to patients. It was presented by Prof Faisal Ghani for Farabi Medical College medical students.
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L-19 Truth Telling & breaking bad news (BBN) (Prof.faisal)
- 1. BREAKING BAD NEWS PROF. FAISAL GHANI SIDDIQUI MBBS; FCPS; PGDIP-BIOMEDICAL ETHICS; MCPS-HPE
- 2. WHAT IS A BAD NEWS?
- 3. WHAT IS A BAD NEWS? Any information that adversely and seriously affects an individual’s view of her/his life
- 4. WHAT CONSTITUTES BAD NEWS? • Disclosing • diagnosis of cancer • cancer recurrence • Metastases • Positive genetic test results • Announcing death of parent/spouse/child
- 5. BREAKING BAD NEWS: WHY IS IT IMPORTANT?
- 6. Conceal truth / withhold information to Avoid discomfort to the patient Lying to patient Obstructing autonomy
- 7. PATIENT AUTONOMY Ethical & legal obligation on the physician to provide patients with as much information about their illness as they desire
- 8. Truth may be disclosed without concern for patient’s sensitivity Discomfort
- 9. Avoid discomfort of the patient and withhold information Lie Truth may be disclosed without concern for patient’s sensitivity Discomfort
- 10. BREAKING BAD NEWS IS DIFFICULT
- 11. 5 STAGES OF GRIEF AND LOSS
- 12. 5 STAGES OF GRIEF AND LOSS –KUBLER ROSS MODEL Denial Anger DepressionBargaining Acceptance
- 13. 5 STAGES OF GRIEF AND LOSS –KUBLER ROSS MODEL DENIAL Person denies the facts when he receives bad news ANGER Develops anger, irritation, jealously and resentment DEPRESSION Feelings of helplessness develop. May take refuge in alcohol and drugs. BARGAINING Tries to get away from the truth in different ways ACCEPTANCE Accepts the fact that there is no more hope
- 14. do you remember the reaction of the companions to the death of the prophet (PBUH)?
- 15. BREAKING BAD NEWS IS DIFFICULT
- 16. … BUT IT CAN BE LEARNT
- 17. THE SIX STEPS OF SPIKES S SETTING UP the interview P Assessing the patient’s PERCEPTIONS I Obtaining patient’s INVITATION K Giving KNOWLEDGE to the patient E Addressing patient’s EMOTIONS with empathy S STRATEGY and SUMMARY
- 18. STEP 1: SETTING UP THE INTERVIEW • Privacy: a private location, such as an interview room • Involve family members for support • Sit down • Do not interrupt the patient when (s)he is talking • Manage time constraints and interruptions
- 19. STEP 2: ASSESSING PATIENT’S PERCEPTION “BEFORE YOU TELL, ASK” • Find out what patient knows about her/his illness • Will help you understand how much patient knows about the seriousness of her/his disease
- 20. STEP 3: OBTAINING PATIENT’S INVITATION Although most patients want to know all the details about their medical situation, you can't assume that this is the case. Obtaining overt permission respects the patient's right to know (or not to know)
- 21. STEP 4: GIVING KNOWLEDGE • Use the same language your patient uses • Don’t use medical jargon • Give information in small chunks • Clarify patient’s understanding
- 22. STEP 5: ADDRESSING PATIENT’S EMOTIONS WITH EMPATHY • Acknowledge patients emotions • Tell her/him that these emotions are normal
- 23. STEP 6: STRATEGY AND SUMMARY • Summarize the information • Give patient an opportunity to ask questions • If you don't have time to answer tell your patient that this issue can be discussed in detail during next interview
Editor's Notes
- Fifty years ago, many physicians were able to avoid discomfort by concealing the truth from patients, justifying this deceit with the claim that it would be too distressing for the patient.
- A Definition of Bad News Bad news may be defined as “any information which adversely and seriously affects an individual's view of his or her future” [13]. Bad news is always, however, in the “eye of the beholder,” such that one cannot estimate the impact of the bad news until one has first determined the recipient's expectations or understanding. For example, a patient who is told that her back pain is caused by a recurrence of her breast cancer when she was expecting to be told it was a muscle strain is likely to feel shocked.
- There are many clinical situations during which this news delivery could occur: ● Disclosing the diagnosis of cancer ● Discussing cancer recurrence or failure of treatment to impact disease progression ● Disclosing metastatic disease ● Discussing the presence of irreversible disease or serious treatment toxicity ● Disclosing positive results of genetic tests ● Announcing the death to spouse
- Fifty years ago, many physicians were able to avoid discomfort by concealing the truth from patients, justifying this deceit with the claim that it would be too distressing for the patient.
- Principles of informed consent, patient autonomy, and case law have created clear ethical and legal obligations to provide patients with as much information as they desire about their illness and its treatment. Physicians may not withhold medical information even if they suspect it will have a negative effect on the patient. Yet a mandate to disclose the truth, without regard or concern for the sensitivity with which it is done or the obligation to support the patients and assist them in decision-making, can result in the patients being as upset as if they were lied to [4]. As has been aptly suggested, the practice of deception cannot instantly be remedied by a new routine of insensitive truth telling [31].
- principles of informed consent, patient autonomy, and case law have created clear ethical and legal obligations to provide patients with as much information as they desire about their illness and its treatment [29, 30]. Physicians may not withhold medical information even if they suspect it will have a negative effect on the patient. Yet a mandate to disclose the truth, without regard or concern for the sensitivity with which it is done or the obligation to support the patients and assist them in decision-making, can result in the patients being as upset as if they were lied to [4]. As has been aptly suggested, the practice of deception cannot instantly be remedied by a new routine of insensitive truth telling [31].
- principles of informed consent, patient autonomy, and case law have created clear ethical and legal obligations to provide patients with as much information as they desire about their illness and its treatment [29, 30]. Physicians may not withhold medical information even if they suspect it will have a negative effect on the patient. Yet a mandate to disclose the truth, without regard or concern for the sensitivity with which it is done or the obligation to support the patients and assist them in decision-making, can result in the patients being as upset as if they were lied to [4]. As has been aptly suggested, the practice of deception cannot instantly be remedied by a new routine of insensitive truth telling [31].
- Fifty years ago, many physicians were able to avoid discomfort by concealing the truth from patients, justifying this deceit with the claim that it would be too distressing for the patient.
- Stage 1: Denial Initially, person denies the facts when he receives bad news as general defence mechanism. He will start searching for someone to blame. Stage 2: Anger Feelings of anger, irritation, jealously and resentment arise (Sometimes directed at the bearer of the bad news.) Stage 3: Depression Person feels helpless and misunderstood. There is a chance that they could take refuge in alcohol and drugs. Stage 4: Bargaining At this stage, person tries to get away from the dreadful truth in many different ways. This stage involves bargaining. Stage 5: Acceptance When the person involved becomes aware of the fact that there is no more hope, he can accepts the fact. He may take up activities again and will start making plans for normal life. .
- Fifty years ago, many physicians were able to avoid discomfort by concealing the truth from patients, justifying this deceit with the claim that it would be too distressing for the patient.