بسم الله الرحمن الرحيم

1. بسم الله الرحمن الرحيم

2. Breaking The news S. Balkhy MD FAAP Consultant Developmental Pediatrics Dept of Pediatrics KFSHRC-Gen Org- Jeddah

3. Life after the diagnosis important info for family emotions the grief cycle Breaking the News basic terms Recognize the challenge of sharing bad news effectively describe an effective process for sharing bad news

4. intro

5. Life After Diagnosis Info for families The different stages of the grief cycle

6. Life After Diagnosis • families of children with a serious or terminal illness need to be informed of a no. of issues

7. عن ام سلمه رضي الله عنها قالت سمعتُ رسول اللَّهِ صَلّى اللهُ عَلَيْهِ وسَلَّم يقول َمِنْ عبدٍ تُصِيبُهُ مُصِيبَةٌ فيقولُ : إِنَّا للَّهِ وَإِنَّا إِليهِ رَاجِعُونَ : اللَّهمَّ أجرني في مُصِيبَتي ، وَاخْلُف لي خَيْراً مِنْهَا، إِلاَّ أَجَرَهُ اللَّهُ تعَالى في مُصِيبتِهِ وَأَخْلَف له خَيْراً مِنْهَا . قالت : فَلَمَّا تُوُفِّيَ أَبُو سَلَمَة ، قلتُ كما أَمَرني رسولُ اللَّهِ صَلّى اللهُ عَلَيْهِ وسَلَّم فَأَخْلَفَ اللَّهُ لي خَيْراً منْهُ رسولَ اللَّهِ صَلّى اللهُ عَلَيْهِ وسَلَّم . رواه مسلم .

8. The Grief Cycle • Adapted from “Stages of Dying” by Elisabeth Kubler-Ross

9. Kubler-Ross Model (Five Stages of Grief) • The five stages a dying person goes through after being told about their terminal illness: • denial • Isolation • Anger • Depression • Bargaining • Acceptance.

10. Stages of the Grief Cycle 1. Denial parents may question the diagnosis “This can’t be happening” • Parents may seek second or third opinions • Parents are encouraged to gather information and learn more re their child’s illness • Parents may not be able to process all info

11. Stages of the Grief Cycle 2. Anger • Anger may be directed to spouse, medical staff, or even the system • “Why me?” • Parents’ anger should be normalized and redirected to enable them to advocate for their child

12. Stages of the Grief Cycle 3. Confusion and powerlessness Powerlessness comes from having to count on the advise and expertise of others • “What does this really mean? How will our lives be affected?” • Parents need to empower themselves with knowledge, by learning the language

13. Stages of the Grief Cycle 4. Depression • Things may seem like a constant struggle • Realizing that the illness is real, death may occur unexpectedly • It is not the life they had dreamed of Parents at this stage may need to take brief respite periods to reconnect with self, other family members, or get professional help

14. Stages of the Grief Cycle 5. Guilt and Shame • “What did I do to cause this?” • Guilt can also be related to feeling not doing enough for their child • Parents need to be educated on the causes and encouraged to think positive • Parents may feel shame for not having the perfect child

15. Stages of the Grief Cycle 6. Bargaining It is a way of parents to accept a part of the problem without taking on the whole problem • If this treatment cures my child, I will adopt a poor family” • Parent learn to bargain less and less as they start to have more acceptance

16. Stages of the Grief Cycle 7. Isolation Parents may feel isolated or they seek isolation because their child is different • fears of being judged by others • Parents may find comfort with similarly affected families and over time they may feel comfortable with other families

17. Stages of the Grief Cycle 8. Hope Parents may have moments of hopefulnesswith extended periods of wellness or achievement of milestones • Parents are encouraged to celebrate and share each and every one of these moments

18. Stages of the Grief Cycle 9. Acceptance At this stage, parents feeling some control over the situation and their feelings about it • Acceptance also include realizing that they will have days when previous emotions may resurface • They learn to cope and accept all these feelings

19. إنّا لفراقك يا إبراهيم لمحزونون عن أنس رضي الله عنه أنّ رسول الله صلى الله عليه وسلم دخل على ابنه إبراهيم رضي الله عنه، وهو يجود بنفسه (أي في سكرات الموت)؛ فجعلتْ عينا رسول الله صلى الله عليه وسلم تذرفان؛ فقال له عبد الرحمن بن عوف: وأنتَ يا رسولَ الله؟ فقال: يا ابنَ عوف إنها رحمةٌ، ثم أتبعها بأخرى فقال: إنّ العين لتدمع، وإن القلب ليحزن؛ ولا نقول إلا ما يُرضي ربَّنا، وإنّا لفراقِك يا إبراهيم لمحزونون رواه البخاري.

20. Breaking the news

21. What is Bad News? Any news that seriously and negatively alters the patient’s view of his or her future. Buckman

22. The Goal

23. This is one of our most difficult duties, med. ed. typically offers us little formal preparation.facilitate breaking bad news has been demonstrated to improve patient satisfaction and physician comfort Breaking bad news is a critical skill

24. Why is it a critical skill?

25. Rabow and McPhee keenly describe the end result: “Clinicians focus often on relieving patients’ bodily pain, less often on their emotional distress, and seldom on their suffering.”

26. How Should Bad News Be Delivered? compassionately and effectively

27. ABCDE Mneumonic • Advance Preparation • Build a therapeutic relationship • Communicate well • Deal with patient and family reactions • Encourage and validate emotions

28. ADVANCE PREPARATION

29. ADVANCE PREPARATION

30. BUILD A THERAPEUTIC ENVIRONMENT/RELATIONSHIP

31. C OMMUNICATE WELL

32. D EAL WITH PATIENT AND FAMILY REACTIONS

33. E NCOURAGE AND VALIDATE EMOTIONS

34. E NCOURAGE AND VALIDATE EMOTIONS Naming the feeling “I know this is upsetting” Understanding“It would be for anyone” Respecting“You’re asking the right questions” Supporting“I’ll do everything I can to help you.”

35. عن أبي يحي صهيب بن سنان رضي الله عنه قال: قال رسول الله صلى الله عليه وسلم: (( عجبا لأمر المؤمن إن أمره كله له خير وليس ذلك إلا للمؤمن: إن أصابته سراء شكر فكان خيرا له، وإن أصابته ضراء صبر فكان خيرا له)) رواه مسلم

36. Thank you!