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Delivering Bad News

Amalia Muhaimin Department of Public Health and Community Medicine Division of Bioethics School of Medicine Universitas Jenderal Soedirman

KOMPETENSI
1. Mampu menjelaskan bagaimana interaksi awal dengan pasien dapat membantu tercapainya tujuan akhir dari perawatan pasien dan menentukan tingkat kepercayaan dalam hubungan dokterpasien. 2. Mampu menjelaskan bagaimana cara penyampaian berita buruk dapat mempengaruhi persepsi pasien terhadap diagnosis dan prognosis penyakitnya. 3. Mampu meningkatkan keterampilan komunikasi dalam menyampaikan berita buruk kepada pasien.

Barriers to Effective Communication


Barriers due to patients and families Barriers due to health care providers Barriers due to circumstances

Barriers due to patients and families


Misunderstanding of illness, treatment options and prognosis Biases over the role of palliative care in society and medical profession Lack of knowledge of social, cultural norms, roles and expectations regarding death Re-alignment of roles within the family structure Lack support, lack of coping mechanisms Differences in values, beliefs or culture

Barriers due to health care providers


1. Depth of the physician-patient relationship 2. Personal experiences of illness and death 3. Physical, emotional and psychological stress and depletion 4. Fears of confronting own mortality and fears of death 5. Lack of training and poor role models 6. Fears of emotional outbursts 7. Fears of appearing weak or unprofessional for displaying emotions

8. Personal beliefs & values regarding treatment, death, palliative care 9. Fears of being messenger 10. Guilt and self-blame due to iatrogenic complications resulting in poor quality of life, increased severity of illness and/or death 11. Inconsistent approach to the issues, differences in language leading to confusion and misunderstandings with patients and families

Barriers due to circumstances


Lack of previous relationship with patient and family Lack of privacy Unavoidable interruptions

Starting
Helpful Phrases Would you like me to tell you what the tests show or is there someone else I should talk to? Some people do not want to be told what is wrong with them, but would rather their families be told instead. What do you prefer?

What do they know?


What do you understand about your illness and the tests you have had? How would you describe your health? What did the other doctors tell you about your symptoms or the tests that you have had? What did Dr. Jones tell you when she sent you here? When you first had pain what did you think it could be?

Family
Does everyone understand what has been happening up until this point? Do you have any questions about why we did the tests we did or what they showed up until now?

Are there any further questions before we proceed?

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