Diferencia entre revisiones de «Delivering bad news»
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==Approaches== | ==Approaches== | ||
===GRIEV_ING: (Pnuemonic)=== | |||
*Gather ‐ Get SW in room, | |||
*Resources ‐ +/‐ security, tell attending will have to be gone, get pager/trauma coverage | |||
*Identify person we are talking about, myself and all people in room, identify level of understanding of what has happened already | |||
*Educated ‐ warning shot "I have some bad news." Don't wait too long before saying "___ has died." | |||
*Verify understanding | |||
*Be silent, give the family space to process | |||
*Inquire ‐ questions | |||
*Nuts/Bolts Give contact info | |||
===SPIKES=== | |||
*S - SETTING UP the Interview | |||
**Arrange for some privacy, Involve significant others, Sit down. | |||
Involve significant others, | **Make connection with the patient. | ||
Sit down. | **Manage time constraints and interruptions. | ||
Make connection with the patient. | *P - PERCEPTION | ||
Manage time constraints and interruptions. | **"What have you been told so far?” | ||
**Assess receiver's level of health literacy. | |||
*I - INFORM | |||
**Briefly explain chronology of events leading up to death (or bad news) | |||
**Avoid euphemisms | |||
*K - Knowledge | |||
**Allow receiver to ask questions. | |||
*E - Empathy | |||
**Validate emotions of grieving. | |||
**Say "I'm sorry." | |||
*Summary and Strategy | |||
**Acknowledge questions may arise after processing, establish your availability to be reached by social work in they have questions that come up when they see their loved one. | |||
** Leave receiver with social work. "I'm going to step out and let (the social worker) help you with the next steps" | |||
==Tips== | ==Tips== | ||
Revisión del 20:02 28 jun 2016
Background
- Physicians must disclose bad news to family members - often times unexpected notification of death can be difficult for family.
- The process can be challenging for providers.
- Using a structured approach can help alleviate the emotional challenging of delivering the bad news.
- Think of delivering bad news as a procedure (with a pre-procedure time out, a structured approach to the delivery of bad news, and requesting a colleague in the ED to hold your phone or take any runs that come in while you are in your critical five minutes of breaking the news.
Types
- Notification of death
- Informing of poor prognosis e.g. "It's not my job to take away all hope, but I am very worried about _ and he/she is very sick"
Procedure
- Time Out Before the Procedure (Mandatory)
- Confirm identity of patient and family specifically that family is TRULY the family of the patient. Can be difficult when the patient arrives as a "Joe Doe" without family. Before having meeting, identification processes (social work can assist) with confirming age, demographic, location that patient came from (can be found on the EMS run sheet).
- Confirm that you known the name of the patient so that way you can refer to him/her by his/her name. Ask social work if they know the names of the family and/or their relation to the patient.
Approaches
GRIEV_ING: (Pnuemonic)
- Gather ‐ Get SW in room,
- Resources ‐ +/‐ security, tell attending will have to be gone, get pager/trauma coverage
- Identify person we are talking about, myself and all people in room, identify level of understanding of what has happened already
- Educated ‐ warning shot "I have some bad news." Don't wait too long before saying "___ has died."
- Verify understanding
- Be silent, give the family space to process
- Inquire ‐ questions
- Nuts/Bolts Give contact info
SPIKES
- S - SETTING UP the Interview
- Arrange for some privacy, Involve significant others, Sit down.
- Make connection with the patient.
- Manage time constraints and interruptions.
- P - PERCEPTION
- "What have you been told so far?”
- Assess receiver's level of health literacy.
- I - INFORM
- Briefly explain chronology of events leading up to death (or bad news)
- Avoid euphemisms
- K - Knowledge
- Allow receiver to ask questions.
- E - Empathy
- Validate emotions of grieving.
- Say "I'm sorry."
- Summary and Strategy
- Acknowledge questions may arise after processing, establish your availability to be reached by social work in they have questions that come up when they see their loved one.
- Leave receiver with social work. "I'm going to step out and let (the social worker) help you with the next steps"
Tips
- If family asks if they suffered, consider (assuming it would not be obviously a lie) what if any utility there would be to saying anything other than: "No, he/passed peacefully." After all, our patients are also the family of the deceased.
External Links
References
- Emergency Medicine Conference at Boston Medical Center 2015. Contributions by multiple facutly (including Dr Jeffrey Schneider and BMC EM residents
- Lowry, Fran. Think GRIEV_ING When Giving Bad News to Loved Ones. ACEP News
April 2007
- SPIKES—A Six-Step Protocol for Delivering Bad News: Application to the Patient with Cancer, Baile, et al. The Oncologist. Jun 2000. (http://theoncologist.alphamedpress.org/content/5/4/302.full)
- Shoenberger, Jan MD et al. Death Notification in the Emergency Department. Western J Emerg Med. 2013;14(2):181-185.