Examiner feedback from the free mock session conducted on 17/06/2024
Overview
Goal: Deliver a difficult prognosis (in this case, terminal dementia) with sensitivity and clarity.
SPIKES Framework:
S: Setting (ensure patient comfort and privacy)
P: Perception (assess patient's understanding of the condition)
I: Invitation (ask if the patient wants anyone else present)
K: Knowledge (provide information in a layered, empathetic way)
E: Emotions & Empathy (acknowledge and validate the patient's feelings)
S: Strategy & Summary (outline the plan and offer support)
Specific Feedback and Tips
Data Gathering:
Focus: Prioritize information directly relevant to the diagnosis and management plan.
Key Questions:
How much does the patient understand about dementia?
Who is the primary caregiver and what support do they have?
What has the patient been told so far?
Perception:
Bridge the Gap: Help the patient connect the symptoms (weight loss) to the underlying condition (dementia).
Explain: Dementia is progressive, irreversible, and weight loss is a terminal symptom.
Invitation:
Normalize: Offer the option for someone else to be present, but don't dwell on it if the patient declines.
Transition Smoothly: If the patient declines, move directly into providing information.
Knowledge Delivery:
Layer Information: Connect weight loss, dementia, and its terminal nature.
Emphasize: Explain why further aggressive treatment is not beneficial.
Reveal Diagnosis: "Unfortunately, this is the terminal stage of dementia."
Emotions & Empathy:
Pause: Allow the patient time to react after the diagnosis.
Validate: Acknowledge their emotions and offer support (e.g., tissues, water).
Check In: Ask if they're okay to proceed.
Strategy & Summary:
Introduce Palliative Care: Explain its focus on comfort and symptom management.
Address Concerns: Be prepared for questions about treatment options, going home, etc.
Offer Support: Provide information on hospice, support groups, or other relevant resources.
Closing:
Summarize: Briefly recap the key points.
Follow-Up: Offer to arrange a meeting with their GP or other healthcare providers.
Provide Resources: Offer pamphlets or leaflets on palliative care.
Additional Tips
Time Management: Be mindful of time constraints and avoid unnecessary data gathering.
IPS: Demonstrate empathy and concern throughout the interaction.
Tailor Your Approach: Be prepared for different patient reactions and adapt your responses accordingly.
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