1. Please review the services provided by Indiana and reflect. Please connect your reflection to what we discussed in class and how this information could be helpful for you now or in the future. (This pertains to Link 1).
2. Please review 4 boxes within link two and reflect. Please connect your reflection to what we discussed in class and how this information could be helpful for you now or in the future.
3. Please explore link three and reflect. Please connect your reflection to what we discussed in class and how this information could be helpful for you now or in the future.
4. Please explore one caregiving topic within link four and reflect. Please connect your reflection to what we discussed in class and how this information could be helpful for you now or in the future.
5. Please explore one topic within link five and reflect. Please connect your reflection to what we discussed in class and how this information could be helpful for you now or in the future.
Patient-Provider:
Discussing Bad News &
End of Life
Communication
Day 1
7
Agenda
PPC-Discussing Bad News & End
of Life Communication
Activity
Homework
Provider Skills for (PCC)
Active listening
Therapeutic interviewing
Advice giving
Empathy
Bad news delivery
1.
2.
3.
4.
5.
Bad News Delivery
as the process of health care providers presenting unfavorable medical information or
diagnoses to patients and/or their families that likely is unwelcome or disturbing
patients or patients’ families should not be given false hope, but instead must be presented
with accurate and truthful
information
(Mattson & Hall, 2011)
Setting
the environment of the health communication exchange and creating a
maximally conducive situation for the delivery of bad news
location of conversation is important to consider
quiet location
eye-level
should not appeared rushed
block out potential interruptions
sustained eye contact & touching arm
(Mattson & Hall, 2011)
Perceptions of Health Status
determining perceptions of
health status allows health care
providers to correct any false
information and provide needed
explanations
reveal patients’ and/or their
families’ technical knowledge
of their health situation as
well as their emotional
condition
(Mattson & Hall, 2011)
feelings about the state of an individual’s own health or the health of another
providers talk with patients and/or families about how much
information and in how much detail they would like to know about
their health and by what means they would prefer to receive that
information
respects that patients and their families are unique and
have different informational needs and desires
Invitation
(Mattson & Hall, 2011)
Knowledge
consider medical knowledge of
recipients
provide information in small chunks
check of level of understanding
and emotional state
when the bad news is told to patients and/or their families
can provide a warning
“I am sorry to have to tell you…
”
“Unfortunately…”
avoid being excessively blunt
“You have cancer and have weeks to live”
(Mattson & Hall, 2011)
Providers must be aware of patients’ and/or families
emotional responses whether overt (crying) or more
introverted (silence)
Providers need to name or identify the emotions expressed to
themselves. If unsure, ask patients/their families
Providers should identify reasons for the emotions
“My patient is scared because the radiation did not shrink the tumor”
Providers should voice an empathetic response that names
and validates patients’ and/or their families’ emotions
“I understand that you are feeling frightened because of the poor
test results”
1.
2.
3.
a.
4.
a.
Emotions/Empathy
Four-Step Technique for Responding to Emotions and
Providing an Empathetic Response
address and respond to patients’ and/or their families’ emotions
while expressing empathy
(Mattson & Hall, 2011)
Summary
provide a summary of the information provided & present a
strategy for future treatment
focus on creating a mutual plan for
making the patients and/or families
as comfortable and contented as
possible
focus on creating a mutual plan for
making the patients and/or families
as comfortable and contented as
possible
(Mattson & Hall, 2011)
Key Points from
Brandt (2013)
“However, sometimes when patients ask a
direct question, they’re less sure they want a
direct answer. So one of the things I try to do
is make sure the patient actually wants the
information he or she is asking for, and
whether the timing and setting are correct.
Often when probed, patients are not ready to
hear difficult information, or they might need
some time or a loved one present.”
(Brandt, 2013, para. 5)
(Dr. Kavitha Jennifer Ramchandran)
“Ask permission. Patients can tell me
whether they’re ready to receive certain
information.”
“Establish a comfortable setting. No one
can talk when they are in pain or
uncomfortable.”
“Make sure the right players are in the
room. Some patients can’t make a decision
without their partner, a parent, or a child
present.”
“If patients don’t want information, find
out who they want us to communicate
with. Establish a surrogate decision-
maker.”
1.
2.
3.
4.
(Brandt, 2013, para. 7)
(Dr. Kavitha Jennifer Ramchandran)
“I usually provide a care map or plan with
clear lefts and rights. I let people know that I
have a certain number of tools in my toolbox
but at some point, those tools will no longer
be effective and the disease will become
more difficult to control. I try to focus on the
“disease” rather than the “fight” because
basically even with all of our best efforts,
some of these diseases are not curable. This
isn’t the fault of the patient or the physician.”
(Brandt, 2013, para. 11)
(Dr. Kavitha Jennifer Ramchandran)
“Absolutely. Their journey is just beginning,
while their loved ones’ journey is ending. It’s a
different path and struggle. The same
questions and rules apply around information
giving, kindness, and making a plan.”
(Brandt, 2013, para. 14)
(Dr. Kavitha Jennifer Ramchandran)
”
(Brandt, 2013, para. 19-20)
“Be humble. We’re not in their shoes. Be kind.
Do unto others as you would want done to
you. Listen carefully. A hug is okay in the
right setting. It’s okay to cry at times…
Cancer sucks.”
“At the end of the day, find the things that
keep you whole and happy… It will let you do
all the right things again the next day.”
(Dr. Kavitha Jennifer Ramchandran)
(Dr. Kavitha Jennifer Ramchandran)
KEY POINTS FROM
NGO-METZGER ET
AL. (2008)
Li et al. (2020)
Malhotra et al. (2020)
RA 10 Due by 11:59 pm ET
Podcast
PATIENT-
CAREGIVER
COMMUNICATION
Day 18
AGENDA
Review
Li et al. (2020)
Malhotra et al. (2020)
Activity
Homework
emotional support
providing empathy & emotional convos (CAREGIVER
NEEDS)
cared for, supported, understood, encouraged,
(PATIENT NEEDS)
diagnosis and final stage
daily life
breast, ovarian & rectal cancer
info about eating, exercise, and
maintaining a healthy weight
metastatic breast cancer
normal working life
maintain QOL
head and neck cancer
using the bathroom
sex/fertility
about sex history (diagnosis) (PATIENT)
fertility after diagnosis (PATIENT)
death
clarify knowledge of death & how to COM
with the patient (CAREGIVER)
widowers talk about death-prepare to say
goodbye (CAREGIVER)
“Cancer Patients & Caregivers have diff COM needs”(p. 1)
Style (HOW-COM style)
honesty, compassion, patience, respect, and balance btw truth and hope (BOTH)
empathy, competence, honesty, patience & respect (PATIENTS)
empathy and sincerity (BOTH)
struggled with authenticity and hope balance (BOTH)
Australia-providers use direct language about death (PROVIDERS)
ability to ask questions
easy words to understand
importance of delivery (caregiver and provider, step by step from providers to patients)
personalized advice
diff com for diff stages of cancer
diff COM channels (FTF, a phone call- older) (social media and the Internet)
Timing (WHEN-COM timing needs)
info early on (BOTH)
say goodbye
before things are needed
when things become bad
LI ET AL. (2020) (P. 6) (CONT.)
MALHOTRA ET AL. (2020)
oncologist-patient/caregiver communication intervention
TEAMS
“training oncologists and empowering patients in effective
communication during medical consultation in Singapore” (p. 1)
Feasible & acceptable to oncologists
Improved more empathic responses (oncologists)
Improved oncologist-patient/caregiver
prognosis
goals of care
frequency
RA 11 Due by 11:59 pm ET
Work on Podcast
Communicate as a Caregiver
Communication Tips
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