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How To Disclose The Diagnosis

Consistency, competence, communication and cohesion are key aspects of effectively breaking bad news according to this document. The document provides guidance on preparing, delivering the news with empathy, dealing with reactions, and encouraging emotions. It emphasizes truth, simplicity, hope and ongoing support.

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Ram Sharan Mehta
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45 views18 pages

How To Disclose The Diagnosis

Consistency, competence, communication and cohesion are key aspects of effectively breaking bad news according to this document. The document provides guidance on preparing, delivering the news with empathy, dealing with reactions, and encouraging emotions. It emphasizes truth, simplicity, hope and ongoing support.

Uploaded by

Ram Sharan Mehta
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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How to Disclose the Diagnosis

Breaking Bad News


Background
Breaking bad news:
 Basic skill
All discipline of medicine
Insensitive approach- distress, poor
adjustment, psychiatric illness, litigation
Many doctors-ill equipped, find stressful
Ignored area of medicine
Mainly, learn by observing seniors
What is sad/bad news ?
Information contains serious adverse
consequences for patient and their families

 Defined as "any information that produces


negative alteration to receiver’s present and
future prospective"
Conditions

Life threatening illness/terminal illness :


 Malignancy
 HIV/AIDS
 Irreversible systemic failure
 Disabling operations, e.g. amputation
Chronic debilitating illnesses
Why is breaking bad news difficult?
Breaking bad news is unpleasant- emotionally
charging

Our own psychology- fear of death

No one likes to tell someone that his or her life


is about to change adversely

No one enjoys seeing another person cry or


experience pain
Cont……
 avoids confrontation of own feelings about death
and the dying process

senders own negative emotional reactions to the bad


news
Reaction to bad news:
Mild/moderate to Severe
Depends on:
Degree of badness
Past experience
Expectation
Personality;- immature, emotionally unstable
Spiritual belief
Philosophical standpoint
Perceived social support
 Way of receiving information
Severe Rx to Bad News ( Klubler Ross)
1. Denial: “Daze” “No, not me !”
anxiety
2. Anger: “Why me ? ”
 Patient is irritable, demanding, critical
 Angry at themselves, caretakers, doctors,
God
3. Bargaining: “Yes, me, but……..”
 Buy additional time
 Reaffirm faith in God/Natural Power
4. Depression: “Yes, me”
* Impending loss of everything
* Pervasive despondency

5. Acceptance: “Yes, me and I am ready”


* Accepts inevitability
 Not every one passes through those stages
 Vary in time duration
General Guidelines for Disclosure:
In past – no disclosure
Current, disclosing diagnosis has become the norm,
and we now have legal and ethical obligations to tell
our patients any detail about their illness, if that is
pts’ wish
American Hospital Association (1973): “Patients’ Bill
of Rights” pts have a “right to obtain complete current
information regarding diagnosis, treatment, and
prognosis in terms the patient can be reasonably
expected to understand”
Third view - flexible approach consideration of
psychological, social and personal factors
Communication of Bad News

Keys – breaking bad news


Plan well
develop strategies based on personal,
cultural & social experiences
Empathy, compassion, involvement are
essential
Good listener
Strategies- Communicating Bad News
1. Planning Before Starting:
 Difficult task
 Confirm diagnosis, prognosis
 Clear management plan
 Answers for possible queries
2. Delivery the news:
 Graded
 Many do not want to hear at once
 What the pt. knows already & what the pt. wants to know
 Tailor information to each pt’s concern, knowledge and
understanding
 Simple language
3. Give time to integrate information
 Crowded information may confuse
 Give time to ask questions

4. Soften bad news with good news


 Patient wants information that provides hope
 Focus on positive symptoms
 Tell about most favorable outcome of particular ill
 Convey you are always ready for help

5. Never tell falsehood:


 Maintain trust
What to tell ?

The truth if at all possible


Use simple non-technical language
Tell calmly
Tell treatment options

When to tell ?
When all relevant results are available
With implications of Rx and prognosis can be
given
Whom to tell ?
To the pt but use discretion when prognosis
is very poor
Closest relatives
Where to tell ?
In privacy (when can give adequate time)

Who tells ?
The health team leader (Physician)
But each consultant has his own policy
Summary: (ABCDE)
A.-Advance preparation

B.-Building a therapeutic relationship

C.-Communicating well

D.-Dealing with the patient and family reactions


and
E.-Encouraging/validating emotions ( empathy)
Seven Cs of Care of Terminally Ill patient
Concern : Compassion, worth, tender and involvement.
Competence: Skill and knowledge about illness management
eg pain, nausea, shortness of breath, insomnia.
Communication: allowing patient to speak
Children: Allowing children to visit patient , brings consolation.
Cohesion: Family cohesion
Cheerfulness: Gentle and appropriate sense of human.
 Humor can be palliative.
Consistency: Continuing, persistent attention and involvement
till the end.

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