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Bad News Communication: A 6 Step Approach to Use & Teach Gary Winzelberg, MD MPH FACP Division of Geriatric Medicine Palliative Care Program The University of North Carolina at Chapel Hill With Support from The Donald W. Reynolds Foundation Copyright © 2012 The University of North Carolina School of Medicine at Chapel Hill Objectives • Recognize bad news communication as a core physician skill • Understand the six basic steps used to initially deliver bad news • Practice giving feedback to a resident whom delivered bad news • Identify & discuss challenges of providing feedback about a sensitive topic 7/21/2015 2 Today’s workshop • Folder with group lists, physician information sheets and resident evaluation forms • 2 cases with SPs – Jennifer Hawkins (breast cancer) and Pat Smith (colon cancer) • Choose 1 group member to share bad news (maximum 10 minutes) • Other group members observe, give feedback (maximum 5 minutes) » Use evaluation form to help structure feedback • • • • SPs will switch rooms after 15 minutes Share bad news with 2nd SP, give feedback Large group discussion Lunch 7/21/2015 3 Delivering Bad News -- Procedure • Interpersonal & communication skills – ACGME core competency & common program requirement • “Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals.” • Bad news communication = skill to teach, evaluate, improve 7/21/2015 4 Difficulties in Communicating Bad News • Many physicians feel unprepared • Discomfort with strong emotion • Desire to protect the patient • Desire to soften the bad news 7/21/2015 5 Bad News • Any information threatening to a patient’s health, sense of wellbeing • Examples: cancer, chronic diseases, pregnancy, developmental delay • Six step communication approach » Evidence-based » Expert opinion 7/21/2015 6 1. Set up the interview • Preparation » Review history & data – know the facts » Decide with learner how news will be communicated • What will happen if encounter doesn’t go well? » » » » 7/21/2015 Setting Involve significant others Sit down Manage time constraints and interruptions 7 2. What does the patient know? • Before you tell, ask. • Assess the patient’s ability to comprehend 7/21/2015 8 3. Obtain the patient’s invitation • Some patients don’t desire full information • May address prior to test ordering 7/21/2015 9 4. Share the information • Give a warning shot » Unfortunately I have some bad news to share » I wish I didn’t but I have bad news about your test result • Stop, wait, and listen • Minimize jargon • Give information in small chunks 7/21/2015 10 5. Address emotions • Observe • Name the emotion • Legitimate » Many people would feel… • Explore • Make empathic statements » I can see how upsetting this is to you » I realize that this is a shock » I was also wishing for a different result 7/21/2015 11 6. Planning and follow-up • Next steps • Timing of future communication • Contact information • Patient support 7/21/2015 12 Evaluation Form • Includes feedback on each of six steps • This session: Focus feedback on #4 and #5. • Identify strengths and areas for improvement 7/21/2015 13 Acknowledgements and Disclaimer This project was supported by funds from The Donald W. Reynolds Foundation. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by The Donald W. Reynolds Foundation. The UNC Center for Aging and Health, the UNC Division of Geriatric Medicine also provided support for this activity. 7/21/2015 14 Copyright © 2012 The University of North Carolina School of Medicine at Chapel Hill 7/21/2015