Question

Discuss the basic framework for structuring conversations with patients and families for both breaking bad news and negotiating goals of care.

Answer 1

Communication is the essence of health care .timely communication of the disease progression helps to relieve anxiety in patients and relatives.breaking the bad news to a patient and relatives in a gracefully manner needs an experienced physician with excellent communication skills .gone are the times of false assurance nowadays patients are more open to discussion and knowing the fact .A structured method for breaking the bad news are using the abbreviation spiikes

S= SETTING Before you break the bad news arrange an appropriate setting for the conversation where the fimily,patient can be comfortable,provide privacy, preferably make them sit before you start talking,involve all the significant others so space constrained should not be a problem .

P=Patients perception assess the patients perception before you start the conversation.to know what they already know will help you to plan how to go about with the discussion .this will help you know what is there fear and anxiety .How hopefull they are

I=invitation Before you go ahead with the bad news wait for the patients or relatives invitation to speak let them show s desire to listen ,discuss from you .you can ask can I share you the test results avoiding can be a negative sign of not wanting to know any information

K=knowledge give patients adequate knowledge and information it can be by tell the patients that you have a bad news to share.do not use medical jagrans or terminologies which a lay man may not understand eg instead of sepsis you can use infection spread .speak in simple language ,avoid being very blunt,talk assertively yet gentle .Give them treatment alternative available for the stage of disease they are going through even if it is only pain management and comfort Care

E =Address the patients emotions with empathy once you break the bad news it's obvious patient will have certain emotions expressed in the form of tearfulness,silence give them enough time to express emotions you can touch the patient or leave the relatives and patient for sometime do not hurry .ask if they are silent using open ended questions.show empathy at all instance do not judge the patient

S strategies and summary
Now the physician has to summarise what he spoke it's essential to understand the patients and relativels have comprehended the expected conversation incase of any wrong understanding or doubts it should be cleared .Physician should also at this stage provide with various treatment alternative even if it is palliative care .this will make the patient cared for and physician being responsible .

The additional step in treatment goal negotiation is of periodically assessing the patient for any change in treatment plan and redefining the treatment goal