Integrating Patient- and Family-Centered Care Principles into a Simulation-Based Curriculum: Dartmouth-Hitchcock Medical Center

Integrating Patient- and Family-Centered Care Principles into a Simulation-Based Curriculum: Dartmouth-Hitchcock Medical Center

• 1.
  Effective Patient Communication Module 2: Sharing Bad News Module development supported by a grant from the Picker Institute / Gold Foundation 2010 Challenge Grant
• 2.
  Learning Objectives  Definebad news  Demonstrate use of the SPIKES model when sharing bad news with the patient  During the patient encounter, attend to the major emotional components of sharing bad news, especially expressions of fear, anger, sadness, denial, and guilt 3
• 3.
  Expected Outcomes  Recognizechallenges and supports to effectively sharing bad news with the patient & family  Demonstrate the SPIKES model communication strategy when sharing bad news with the patient & family  Demonstrate empathy when sharing bad news with the patient 4
• 4.
  The Task ofBreaking Bad News “If we do it badly, the patients or family members may never forgive us; if we do it well, they may never forget us.”(Buckman, 1992) 5
• 5.
  What is BadNews? Information that negatively alters the patient’s view of the future (Buckman, 1992) (Tissot, 1872) 6
• 6.
  Challenges  Lack of:  Guidelines  Training  Experience  Good role models  Concerns of:  The provider (Siegmund, 2008)  The patient & family 7
• 7.
  Supporting Patient &Provider  Patient & Family are supported by:  Being included in conversations & planning  Being treated as care partners  Provider is supported by:  Training & Practicing good communication skills  Learning ways to effectively cope with emotionally charged issues  Having another person available who knows the patient 8
• 8.
  SPIKES Model: TheSix Steps  Setting  Perception  Invitation  Knowledge  Emotions  Strategy & Summary Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. SPIKES-A Six-Step Protocol for Delivering Bad News: Application to the Patient with Cancer. The Oncologist, 5, 302-311; 2000. SPIKES mnemonic used with permission. 9
• 9.
  Setting the Environment Provide privacy  Introduce self  Determine who else should be present  Ensure no interruptions  Provide comfortable space  Create welcoming environment 10
• 10.
  Perception  Prepare before speaking  Ask about patient’s perception of what is going on (Renoir/ Bjoertvedt, 2010) 11
• 11.
  Invitation  Ask questions to invite the patient into conversation  Ask how much information the patient wants to hear (Pissarro, 1881) 12
• 12.
  Knowledge  Deliver themessage  Use plain language  Be mindful of body language  Get to the point  Give information in small chunks  Pause  Wait for reaction  Use “teach back” to verify that message was received 13
• 13.
  Emotions and Empathy Be prepared for patient’s and family’s emotional response  Anticipate fear, anger, sadness, denial, guilt  Be mindful of your own response  Comfort the patient 14
• 14.
  Strategy and Summary Assess patient’s readiness for planning  Negotiate next steps  Verify support structure  Acknowledge & answer questions  Summarize plan  Use “teach back” technique  Follow-up 15
• 15.
  Video ©2009 –“Sharing BadNews” Henry Ford Health System Department of Medical Education Video clip used with permission. 16
• 16.
  Discussion of theVideo  How well did the doctor handle the situation?  What worked well?  What could have been handled better?  Have you experienced a scene like the one shown?  What was your role?  Describe the encounter 17
• 17.
  What’s Next? Expectations Reminders (Mahmud, 2008) 18
• 18.
  Special Thanks Module Developmentsupported by a grant from the Picker Institute/ Gold Foundation 2010 Challenge Grant ©2009 –“Sharing Bad News” Henry Ford Health System Department of Medical Education The DHMC Patient and Family Centered Care Department, and Chaplaincy 19
• 19.
  References American Academy onCommunication in Healthcare (AACH). Enhancing Communication Skills. http://www.aachonline.org/?page=EnhanceCommSkills. Accessed October 20, 2010. Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. SPIKES-A Six-Step Protocol for Delivering Bad News: Application to the Patient with Cancer. The Oncologist, 5, 302-311; 2000. Bjoertvedt. File: Auguste Renoir Conversation.JPG. National Museum Stockholm; 2008. Wikimedia Commons. http://commons.wikimedia.org/wiki/File:Auguste_Renoir_Conversation.JPG. Accessed December 6, 2010. Boyle WE, Colacchio TA. Patient and Family Centered Care at Dartmouth-Hitchcock. [DVD]. Lebanon, NH: Dartmouth- Hitchcock Media Services; 2010. Bub B. Communication Skills That Heal. United Kingdom: Radcliffe Publishing Ltd; 2006. Buckman R. How to Break Bad News: A Guide for Health Care Professionals. Baltimore, MD: The Johns Hopkins University Press; 1992. Buckman R. Talking to Patients About Cancer. BMJ, 313, 699-700; 1996. Coulehan JH, Block MR. The Medical Interview, Mastering Skills for Clinical Practice. 5th ed. Philadelphia, PA: F.A. Davis Company; 2006. 20
• 20.
  File: James Tissot-BadNews.jpg. National Museum Cardiff; 1872. Wikimedia Commons. http://commons.wikimedia.org/wiki/File:James_Tissot_-_Bad_News.jpg. Accessed December 6, 2010. File:Pissarro Conversation.jpg. Tokyo: The National Museum of Western Art; 1881. Wikimedia Commons http://commons.wikimedia.org/wiki/File:Pissarro_Conversation.jpg.. Accessed December 6, 2010. Frampton S, Guastello S, Brady C, Hale M, Horowitz S, Smith SB, Stone S. Patient-Centered Care Improvement Guide. Picker Institute; 2008. http://pickerinstitute.org/wp-content/uploads/2010/06/pcc_improvement_guide.pdf. Accessed October 29, 2010. Henry Ford Health System Department of Medical Education. Sharing Bad News. [DVD]. Detroit, MI: Henry Ford Health System; 2009. Lloyd M, Bor R. Communication Skills for Medicine. 3rd ed. London: Elsevier; 2009. Mahmud A. File: Serious Discussion image by Ashfaq.JPG. Dhaka University Institute of Fine Arts; 2008. Wikimedia Commons. http://commons.wikimedia.org/wiki/File:Serious_Discussion_image_by_Ashfaq.JPG. Accessed December 6, 2010. Rider EA, Nawotniak RH, Smith G. A Practical Guide to Teaching and Assessing the ACGME Core Competencies. Marblehead, MA: HCPro, Inc; 2007. Siegmund W. File: Mount Rainier 5839.JPG. 2008. Wikimedia Commons. http://commons.wikimedia.org/wiki/File:Mount_Rainier_5839.JPG. Accessed December 6, 2010. Weiss BD. (2007). Removing Barriers to Better, Safer Care, Health Literacy and Patient Safety: Help Patients Understand, Manual for Clinicians. 2nd ed. American Medical Association Foundation and American Medical Association. http://www.ama-assn.org/ama1/pub/upload/mm/367/healthlitclinicians.pdf. Accessed December 15, 2009. 21