Lecture 10 – Breaking Bad News (Continued) and Developing Compassion in Medicine
Breaking Bad News – Dr. Robert Buckman - SPIKES
-Bad news is information that seriously and adversely affects the patient’s view of his or her future.
-Acknowledge emotion in the room
-Specific strategies for telling someone about bad news, bad news is not related to person giving bad news.
S = Setting (get the setting right) – person breaking bad news is part of setting, behaviour is important.
- Make eye contact; eyes are on the same level.
- Face to face.
- Stand arms length away so there is potential and possibility to touch if needed.
- Stand on your feet and have your hands to your sides or on your knees when bending down, so you are
not all over the place.
- Also ask to come in and if you may sit down.
P = Perceives (what the person perceives) – Before you make a statement, learn and find out what the person
already knows; ask the patient what they already understand and what they already perceive.
I = Invitation (an invitation to share the news) What kind of person are they? Do they like to know the details?
- Accept the patient’s right “not to know” the information; respect their rights.
- Show courtesy
- You need to get clear invitation from the patient in order to break the news.
K = Knowledge (giving the knowledge) – After you know what the patient perceives and has given invitation; align
starting point with the knowledge they already understand.
- Cut the information into bits.
E = Empathize and explore (and exploring the patient’s emotions)
S = Strategies and summarize
Slide 2 – When you need to give information:
C = Context (if on telephone “set agenda”.)
O = Opening shot (talk slowly so they can grasp situation)
N = Narrative (talk slowly, start describing in chronological order of the event or incident)
- “I’m sorry to say…”, “I regret to say…” and then start breaking the news
E = Emotion – let them express their emotions
S = Strategy and summarize
If asked right away “Is he or she dead”: Stop and go to “end” and give expression of regret.
Note: If asking is dead: Anything other than no is a yes.
Slide 3 - Developing Compassion
-Gilbert – a mental orientation that combines care focused qualities of mind and is dependent on those qualities.
-Creates an opportunity for growth and change with warmth.
Slide 4 – Relentless Self-Criticism
-Traumatic events lead to self doubt about actions resulting in guilt, shame, blame oneself, etc – particularly when
it comes to first responders!
-Guilt, shame, etc. can lead to burnout.
-Burnout is a form of depression in which there is decreased ability to show compassion.
- Developing compassion towards others and one’s self as part of a resilient lifestyle may protect against burnout.
Slide 5 – What is compassion? Compassion is not religious business, is human business; it is not luxury, it is essential for our own peace and
mental stability; it is essential for human survival – Dalai Lama
Buddhist – A loving kindness; open heartedness ‘deep feeling and understanding of the suffering of others
associated with a deep commitment and responsibility to try to alleviate it’.
Slide 6 – Slide 8 - Developing Compassion Handout.
Slide 9 – Tools for Helping Paramedics Show Compassion
Why are Tools for showing compassion necessary?
-Tools – modules
-Doctors don’t have the time to be compassionate and it also drains to show empathy. Thus, you use different
strategies or techniques when you have to deal with people going through traumatic events. Eg: Death.
Slide 10 - Tools for Showing Paramedics Care
“I can’t stop crying” (John D. Martin, 1992)
“Trauma, Loss, and Bereavement” (MADD)
Teddy bear program
Slide 11 – 14 Tools to show compassion
-List of ideas for dealing with family and friends, spe