Sunday, April 3, 2011

Station 4 PACES - Break bad news

How a Physician should Break Bad News to a Patient
(Adapted from Ptacekm Eberhardt, 1996), AAN Guideline Summary for Clinicians

Location
  • Quiet , comfortable and private
Structure
  • In person, face to face
  • Convenient time
  • Enough time to ensure no rushing or interruptions
  • Make eye contact and sit close to patient
Participants
  • Have patient's support network available
What is said
  • Find out what the patient already knows about the condition
  • Ascertain how much the patient wants to know about the disease
  • Give a warning comment that bad news is coming
  • Acknowledge and explore patient's reaction and allow for emotional expression
  • Summarize the discussion verbally, in writing and/or audiotape
  • Allow for questions
Reassurance
  • Explain whether the complications of the disease are treatable
  • Indicate that every attempt will be made to maintain function and patient's decision will be respected
  • Reassure that care for the patient will continue
  • Discuss opportunities to participate in research treatment protocols
  • Acknowledge willingness to get a second opinion if the patient wishes
How it is said
  • Emotional manner : warmth, caring, empathy, respect
  • Give news at person's pace; allow patient to dictate what he or she is told
Language
  • Simple words, yet direct; no euphemisms or medical jargon

video

Friday, April 1, 2011

Spot diagnosis

This patient is in Station 3. What is shown and what is in your mind ?