Breaking Bad News with compassion: Father with ICH

Mock examiner feedback from the free mock session conducted on 19/06/24

Initial Preparation

• Understand the Case: Know the diagnosis and the terminal nature of the condition.

• Collect Necessary Information: Gather key details about the patient's medical history and the events leading up to the current situation.

Structured Approach: SPIKES Protocol

• Setting (S):

  • Ensure a quiet, private setting to minimize disturbances.

  • Introduce yourself and your role clearly.

  • Express empathy and prepare the relative for the discussion.

• Perception (P):

  • Assess the relative's understanding of the situation.

  • Ask them to describe what happened, their perceptions, and concerns.

• Invitation (I):

  • Ask if the relative would like someone to join them during the discussion.

  • Prepare them for the news by asking if they want detailed information about the patient’s condition.

• Knowledge (K):

  • Present information in layers, starting with the basics and gradually moving to the terminal diagnosis.

  • Explain the findings from medical investigations (e.g., CT scan) and the implications.

  • Use simple and clear language, avoiding medical jargon.

• Emotions (E):

  • Recognize and respond to the relative’s emotional reactions.

  • Validate their feelings and show empathy.

  • Use the EVE (Emotion, Validation, Empathy) protocol:

• Emotion: Identify the relative’s emotional response.

• Validation: Acknowledge their emotions as legitimate.

• Empathy: Express understanding and compassion.

• Strategy and Summary (S):

  • Discuss the next steps, including what to expect and available support services.

  • Offer leaflets and pamphlets on bereavement services and end-of-life care.

  • Ensure the relative understands the information and provide contact details for follow-up questions.

Key Points to Cover

• Diagnosis Explanation:

  • The patient has a massive brain bleed due to a ruptured berry aneurysm.

  • The condition is terminal and no surgical intervention is possible.

• Management Plan:

  • Focus on keeping the patient comfortable and pain-free.

  • Discuss the patient's current state and what is being done to manage symptoms.

• End-of-Life Considerations:

  • Ask about the patient’s advance directives or wishes regarding end-of-life care.

  • Discuss organ donation if applicable.

• Support for Relatives:

  • Encourage the relative to call other family members.

  • Offer assistance in communicating the news to distant relatives.

  • Provide information about bereavement services for emotional and logistical support.

• Safety Netting:

  • Inform the relative about signs to watch for and when to seek further help.

  • Provide contact information for follow-up questions or concerns.

• Emotional Support:

  • Reiterate your empathy and understanding.

  • Offer follow-up meetings or phone calls for additional support.

Summary

• Setting Up:

  • Quiet, private room; clear introduction and expression of empathy.

• Information Gathering:

  • Focused questions to understand the event and the patient’s medical history.

• Breaking the News:

  • Layered delivery of the diagnosis; clear and compassionate communication.

• Emotional Response:

  • Validate and empathize with the relative’s emotions; use the EVE protocol.

• Next Steps:

  • Discuss end-of-life care, patient’s wishes, and available support services.

• Follow-Up:

  • Provide information for further assistance and support, including leaflets and contact details.