Health Psychology Breaking Bad News (BBN)

Health Psychology Breaking Bad News (BBN). Dr Nazar M Mohammad Amin Professor of Psychiatry M.B.Ch.B ., D.P.M., M.R.C.Psych ., F.R.C.Psych ., F.A.C.P..

Learning outcomes. Preparing medical students to deal with the difficult situation of conveying information to patients that might threaten the future of that patient. Training future physicians to pass those news with other health professionals as a team to the patients. Discuss the consequences of passing those news or hiding those news on the patients and their carers . Realize the differences in the perception of those bad news among various patients.

Definition. Bad News : is any information that creates a negative view in an individual about his/her future . It narrows the choices of the individual regarding his life now or in the future. It threatens the physical and psychological life of the individual and possibly disrupts the life style of the individual..

Common themes of bad news. When a patient is diagnosed with a terminal illness When a patient develops a chronic long standing disease like Diabetes When a patient develops complications of a chronic illness like Renal failure Loss of a loved one in an accident Loss of a close person in the operation theatre Loss of a wanted fetus.

Definition. Breaking Bad News : In health, means sharing information to the patient regarding diagnosis which could include serious illnesses like cancer. It includes newly diagnosed chronic disease or worsening an already diagnosed chronic disease ..

The impact of bad news is on the person, the carers and the doctor who is delivering the bad news. The effect on the person depends on how much that news means to the person(perception) and its impilcations on his life..

Personal perception of the bad news depends on the cultural background of the person, the social circumstances and financial state of that person. Other factors include the person’s age , his familial circumstances especially his or her children etc….

8. Positive effects of bad news. The bad news sometimes relieves the anxiety of the person waiting to receive the news such as confirming the diagnosis of serious illness. The same is true regarding the carers or relatives as they will get relieved from their worries. They will start making arrangements for treatment..

9. When do you pass the bad news to the person concerned?.

10. When do you pass the bad news to the person concerned?.

11. Cultural variations. Across all cultures, patients generally prefer an experienced provider who is empathic and caring, offers hope, and uses the correct wording for difficult conversations (Martins & Carvalho , 2013) to communicate bad news ( Aminiahidashti et al., 2016)..

12. Cultural variations. In China, it is frequently perceived that patients do not wish to have full disclosure of bad news; however, many patients with terminal cancer want to know all the information pertaining to their diagnosis and prognosis ( Tse , Chong, & Fok , 2003)..

13. Cultural variations. Korean Americans and Mexican Americans may not want to be given bad news about their family member with cancer, regardless of the outcome on the patient’s illness or prognosis, for fear that he or she may either choose to “give up” or choose not to proceed with treatment as a result of the bad news ( Tuckett , 2004)..

14. Cultural variations. In some cultures, is taboo and cancer families may be stigmatized when a member of the family is being diagnosed with or being treated for a malignancy ( Abazari , Taleghani , Hematti , & Ehsani , 2016)..

15. Cultural variations. For many Iranian patients, it is important to reduce the stigma of a cancer diagnosis by encouraging a positive outlook on treatment and by reminding the patient that many individuals have cancer or a comorbid condition from cancer ( Abbaszadeh et al., 2014). Offering diagnostic or prognostic information to the patient is considered a duty in Iran, and nurses typically support the patient and his or her family throughout the cancer trajectory ( Abbaszadeh et al., 2014). We should do the same in our region..

16. Cultural variations. In most European countries, US and Australia most patients are informed about their illnesses except in children and those with cognitive impairments. Nevertheless, some eastern European countries have different approaches similar to most Asian countries..

17. Patients have the right to choose not to be told about the details of their diagnosis and lines of treatment. They might ask you to tell their carers about those matters..

18. In a study, it was found that patients preferred to receive the news from doctors who had previous undergraduate training in this field. Psychooncology . 2019 Nov 8. doi : 10.1002/pon.5276. [ Epub ahead of print] Undergraduate training in breaking bad news: A continuation study exploring the patient perspective. Carrard V, Bourquin C, Stiefel F, Schmid Mast M, Berney A..

19. A short BBN simulation-based training can be added to standard clinical rotations. It has the potential to significantly improve self-efficacy, the BBN process, and communication skills.

20. Compassion is not something that can be taught, but rather it is something that can be observed, practiced and later honed. It is by observing these skills in our peers and reflecting on them that we may better ourselves as clinicians.

21. An example from France. “The progressive shifts in the legal and social contexts, along with major changes in information seeking habits with the development of the Internet, have placed patients' information at the core of medical practice. This has to be applied to the psychiatric fields as well, and to questions about how schizophrenic patients are being told their diagnosis nowadays in France.” [Are schizophrenic patients being told their diagnosis today in France?] Review article Villani M, et al. Encephale . 2017..

22. An example from France. “It was found that the practice in France is not adequate and the authors suggest that a consensus conference take place on the subject of schizophrenia diagnostic information in order to elaborate guidelines to support this difficult disclosure.” [Are schizophrenic patients being told their diagnosis today in France?] Review article Villani M, et al. Encephale . 2017..

23. Is it possible to improve the breaking bad news skills of residents when a relative is present? A randomised study I Merckaert et al, Br J Cancer. 2013 Nov 12; 109(10): 2507–2514.

24. Development of a Web-Based Formative Self-Assessment Tool for Physicians to Practice Breaking Bad News (BRADNET) Anne-Christine Rat et al, JMIR Med Educ. 2018 Jul-Dec; 4(2): e17..

25. Development of a Web-Based Formative Self-Assessment Tool for Physicians to Practice Breaking Bad News (BRADNET) Anne-Christine Rat et al, JMIR Med Educ. 2018 Jul-Dec; 4(2): e17..

26. Recommendations for breaking bad news. Diplomacy and compassion should be the guiding priciples The process may need a series of separate conversations Advanced preparations are necessary including checking all investigations and arranging room furniture These conversations should take place in a private, suitable space with the patient on equal terms with the physician.

27. Recommendations for breaking bad news. The patient’s spouse or partner should be present after taking his or her permission Use a clear simple language A gentle, sensible approach will help modulate the patient’s own denial and acceptance Don’t take patient’s angry comments personally.

28. Recommendations for breaking bad news. Never criticize the patient’s response to the bad news Encouraging and answering patients proves your availability for the patient Never give estimates on how long will the patient live Ensure the patient that you will be available to the patient till the end.

29. Recommendations for breaking bad news. The same principles applies for the families and carers.

30. Telling the truth. In general, most patients want to know the truth about their condition. Various studies of patients with malignancies show that 80 to 90 percent want to know their diagnosis. The patient should be asked whether they want to receive the news themselves or someone closely related to the patient.

31. Informed Consent. Patients must be given sufficient information about their diagnosis, prognosis, and treatment options to make knowledgeable decisions This approach may come at some psychological cost; severe anxiety and occasional psychiatric decompensation can occur when patients feel overburdened by demands to make decisions.

32. Clinical Hints. Determine what the patient already knows and understands about the prognosis Stay with the patient for a period of time after informing him or her of the condition or diagnosis.

33. The SPIKES protocol. S Setting and listening skills P Patient ’s Perception I Invitation from patient to give information K Knowledge – giving medical facts E Explore emotions and empathize as patient responds S Strategy and Summary.

34. Conclusion. Every clinician should be trained to be able to deliver bad news to patients The more experienced clinicians are more successful in this difficult task Cultural background of the patient should be taken into consideration Trust, truth and compassion are the main principles in the doctor-patient relationship.

35. abstract.

36. Thank you for your attention.