Courageous Conversations Series
Lesson One: Delivering Bad News ACT Step Two
1. “It’s actually physiologically easier to lie than to tell the truth.” – Soul & Science Lesson
Describe some examples of how care providers may skirt the truth, rather than tell bad news. What might motivate this avoidance? How might those choices affect patient care?
2. “Bad news is always . . . in the ‘eye of the beholder,’ such that one cannot estimate the impact of the bad news until one has first determined the recipient's expectations or understanding. (“SPIKES—A Six-Step Protocol for Delivering Bad News: Application to the Patient with Cancer” 2000)
Six Step SPIKES Protocol for Delivering Bad News
S-Strategy & Summary
What are some methods for determining an individual’s “expectations or understanding”? What questions could be used to discover patient perception, the “P” in the SPIKES process? How can creating an appropriate setting, the “S” in SPIKES, help build that type of open communication?
3.“ . . . breaking bad news is also a complex communication task. In addition to the verbal component of actually giving the bad news, it also requires other skills. These include responding to patients' emotional reactions, involving the patient in decision-making, dealing with the stress created by patients' expectations for cure, the involvement 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 about the prognosis of the illness or purpose of care. - (“SPIKES—A Six-Step Protocol for Delivering Bad News: Application to the Patient with Cancer” 2000)
Of the listed skills (responding to patients' emotional reactions, involving the patient in decision-making, dealing with the stress created by patients' expectations for cure, the involvement of multiple family members, and the dilemma of how to give hope when the situation is bleak) which do you, as a care provider or part of a social support team, find to be most challenging? Why do you find this to be a challenge? How can this skill be strengthened?
4. “Although it may seem contradictory, hoping for the best while at the same time preparing for the worst is a useful strategy for approaching patients with potentially life-limiting illness. By acknowledging all the possible outcomes, patients and their physicians can expand their medical focus to include disease modifying and symptomatic treatments and attend to underlying psychological, spiritual, and existential issues. (“Hope for the Best, and Prepare for the Worst” 2003)
How can you communicate “hoping for the best while at the same time preparing for the worst” in your caregiving environment? How could this same technique be used when giving bad news in other contexts?
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