Breaking bad news and challenge of communication Disclosure - Potential cause of anxiety for healthcare professionals - Source of distress,

dissatisfaction and complaint from the public - Not an isolated skill but a particular form of communication

Bad news definition Any new that drastically and negatively alters the patients view of her or his future It is not only about terminal or curable illness, death and dying Many factors influence the perception of the new making it bad for a particular person at a particular time New maybe bad for the giver as well as the receiver

What makes bad news bad? - Previous experience - People affected - Expectation or hopes - Anxiety about treatment - Uncertainty about the future - Financial implications - Opinions and views of significant people

Impact of the manner of delivery - Setting - Demeanor of the giver - Words used - Time allotted - Pace of discussion

- One or two way exchange

Importance of communication skills Great importance should be given both at undergraduate and postgraduate levels to teach and learn skilled communication for all situations All doctors irrespective of their specialty should be trained to be skilled communicators

Why is it so difficult The main foil is to make things better and certainly not to do any harm There is a risk of causing great use, hurt and distress to recipients to which also causes distress to the giver

What are the difficult situations Talk after post operative diagnosis if malignancy is made Cases where death is imminent Sudden deaths Patients are you especially children If there is no hope Patients or relatives are breaking down Patients are in denial Patients are previously misinformed..

Factors making breaking bad new difficult Fear of hurting or uoepsetting the receiver Discomfort by being with the people who are distressed by the bad news Fear of being blamed Feeling of being the patient Anxiety over how the patient would respond and how to deal with it.

Worry over the possible questions of patients Possible having to admit that one doesn't know all the answers Awareness of lack of knowledge Feeling of inadequacy

Approach of doctors Withholding information Soften the blow Use euphemisms Example, ulcer, wart , tumor, abnormal cell to depict cancer Disguise the malignant nature and may lull the patient and the doctor into a false sense of security

Why do we do it? Patients have the right to any information we have so that they may be empires to take an active part in decision making Doctors have moral, ethical

Doctors should remember Not all patients wat active involvement in decision making We must not force patients into making decisions We should not assume that they have the desire for non involvement

SPIKES STRATEGY S - setting --- privacy, involve significant others, sit down. Look attentive and calm k listening mode: silence and repetition, availability.

P - patients perception

Find out how much the patient knows What de you think was going on with you when you felt the lump What have you been told about all this so far

I - invitation find out how much the patient was to know Re you the kind of person

K - knowledge Hare the information 'unfortunately, I've got some bad news to tell you. Mr. Cruz" Mrs, nots, I'm sorry

E - empathy Step 1 - listen for a nd identify the emotion Step 2 - identify the cause or source of emotion Validation Let the patient know that showing emotion is perfectly normal

S - strategy/summary Educate, summarize and concretize pain of action