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Chapter 6

Chapter 6 . Difficult Conversations. Communicating Bad News . Steps: Provide for privacy Avoid interruptions Identify what the patient knows/suspects Pace the provision of information Schedule an additional appointment. The Cancer Survivorship and Agency Model . Shock Uncertainty

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Chapter 6

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  1. Chapter 6 Difficult Conversations

  2. Communicating Bad News • Steps: • Provide for privacy • Avoid interruptions • Identify what the patient knows/suspects • Pace the provision of information • Schedule an additional appointment

  3. The Cancer Survivorship and Agency Model • Shock • Uncertainty • Empowerment • Agency

  4. End-of-life care conversations • What the concerns are for the patient and family • How the patient and family feel the treatment is going • What the patient and family view as the “worst thing” that could happen

  5. What the “best” thing that could happen might be • What has been most difficult about the illness to date • What are the patient’s and family’s hopes • What is the most important when thinking about the future

  6. Difficult Topics Include: • Miscarriage • Sexual functioning • Alcohol and Substance Abuse

  7. Prochaska’s Stages of Change • Pre-Contemplation • Contemplation • Preparation • Action • Maintenance • Relapse

  8. Principles of changing health behavior • Change is incremental & dynamic • Motivation to change must be internalized • Reinforcement can be positive or negative • Motivation to change is linked to perceived need to change

  9. Social support systems have a direct effect on behavioral change • Patients must believe in their ability to change • Patient support enhances change

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