Breaking Barriers to Effective Communication of Bad News - Obstetric Outlook

Abstract

Breaking bad news demands a great deal of professionalism, patience and energy. This communication requires appropriate kind words and understandable terminology and a secondary task of assessing how the patient and family will respond to the distress. Breaking bad news is a complex communication task. In addition to the verbal component of actually giving the bad news, it requires other skills. These include responding to patients 'emotional reactions, involving the patient in decision-making, dealing with the stress created by patients' expectation for cure, the involvement of multiple of multiple family members and the dilemma of how to give hope when the situation is bleak. The complexity of the interaction can sometimes create serious miscommunications such as patient misunderstanding the prognosis of the illness or purpose of care. (6,7) Poor communication may thwart the goal understanding patient expectations of treatment or involving the patient in treatment planning. Patient Centered Approach Adequate training of the physician which embrace a patient-centered (8) and family centered approach not only keeps the patient at the centre but also has been shown to yield the highest patient satisfaction and results in the physician being perceived as emotional, available, expressive of hope, and not dominant (9). In a patient and family centered approach, the physician conveys the information according to the patients and patient's family's needs. Identifying these needs takes into the cultural, spiritual, and religious beliefs and practices of the family (10). Upon conveying the information in light of these needs, the physician then checks for understanding and demonstrates empathy. This is in contrast to emotion centered approach, which is characterized by the physician emphasizing the sadness of the message and demonstrating an excess of empathy and sympathy. This approach produces the least amount of hope and hinders appropriate information exchange. (9) Discussion There are several accepted ways to break bad  news. These methods include common format of structured listening to what the patient knows and wants to know, giving information in understandable amounts, reacting to the news, and checking for understanding. The SPIKES protocol (6, 7, and 11) is a common template and the acronym stands for Setting up, Perception, Invitation, Knowledge, Emotions and Empathy and Strategy or Summary (Table-2) This approach was designed by Walter Baile and his colleagues at a cancer centre in Houston to accomplish the following while breaking bad news Establishing an appropriate setting  Check the patient s perception of the situation  prompting the news regarding the illness or test result Determine the amount of information known or  how much information is desired. Know the medical facts and their implication  before initiating the conversation. Explore the emotion raised during the interview.  Respond with empathy  Establish a strategy for support.  Rabow and McPhee (12) proposed a model for delivering bad news called ABCDE (Table-3). The other protocols like BREAKS and PACIENTE are summarized in the table-2. Breaking Barriers to Effective Communication of Bad News-Obstetric Outlook Table1. Barriers to effective communication Health care providers Patient Environment Spoken language deficiencies Illiteracy / low literacy level Physical Prejudice based on diagnosis Superstitious, religious and cultural beliefs Long waiting periods Excessive use of jargon by care providers, Multilingual format Preconceived notions Lengthy admission and discharge procedures Unempathetic delivery of bad news Insufficient or poor signage Frequent interruptions No clear designation of duties. Preoccupation with personal matters Poor over process amongst HP Inefficiency or inexperience