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Have You ever heard : ..... ?

Have You ever heard : ..... ?. ‘ There is NOTHING to Do with this patient ’ ‘ Everybody dies ‘ ‘ You are young. You can have another child ’ MISTAKE !. Communicationin palliative care. Prof. Jacek Łuczak AM w Poznaniu. Quality of Life.

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Have You ever heard : ..... ?

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  1. Have You ever heard : ..... ? • ‘There is NOTHING to Do with this patient ’ • ‘ Everybody dies ‘ • ‘ You are young. You can have another child ’ MISTAKE !

  2. Communicationin palliative care Prof. Jacek Łuczak AM w Poznaniu

  3. Quality of Life • Psychological • Physical • Spiritual

  4. Reactions for information about cancer disease (E. Kubler-Ross) • denial, shock, numbness (trance) • anger, soreness, irritation, aggresion • chaffer with destiny - why me ? • depression • acceptation

  5. Emotions during cancer disease: • Anxiety • Anger • Feeling quilty • Depression • Hope

  6. Emotions How are you ? I could not sleep… Something worries me I feel abandoned… I’m dying…

  7. Defensive mechanisms ( adaptation in disease): • Represive mechanisms • Sensitive mechanisms ( subconscious) • Conscious mechanisms

  8. Is it a cancer , doctor ? DON`T PASS OVER IT IN SILENCE !!! • No, but your disease is... • I don`t know, because... • Yes, but ...

  9. Know-how listenings: • Active • Reflective • Empatic

  10. Partnership with the patient • Courtesy in behaviour • Politeness in speech • Not patronizing , Being honest • Listening , Explaining • Agreeing priorities and goals • Discussing treatment options • Accepting treatment refusal

  11. Hope and truth big small false

  12. General strategy • What do you see ? • What do you feel? • What can you do ?

  13. Detailed strategy: • What does your patient need ? • What does his family need ? • Some important issues from patient`s life.. • Let the patient give something...

  14. Distancing Tactics • Premature reassurance • False eassurance • Normalising • Selective attention • Jollying along • Passing the buck • “Turning a deaf ear” • Concentrating on a physical task • Inappropriately introducing humour • Dissappearing from the stressful situation

  15. Breaking Bad NewsHow to do it guidelines( adapted from Mc Master technique ) • Consider where to do it ! • Do NOT begin with an open question • Check patient’s current insight into his/her illness • Fire a warning shot ( eg. I’m afraid it looks more serious than we first thought’) • Pause Take your ‘moving on’ cue from the patient. This may often be nonverbal. Some patients will not want to know more at this stage) • Perhaps use hierarchy of euphemisms (again this may depend on the insight of the patient) • Break the News. Do it clearly and without jargon, (so that the patient is not left with more uncertainties) • Pause • Resist Reassurance • Acknowledge any obvious feelings you witness in the patient ( eg. This is very upsetting for you) • Find out how the patient is feeling. It often helps to prefix what may seem an obvious statement with something like:’ this may seem a silly question but I’m wondering how this has left you feeling right now?’ • Draw out any immediate concerns • Be realistic • Maintain Hope eg. ‘There are things that we can do’

  16. SOME ADVICES • one musn’t respond to all the problems during the first visit • use open questions • be understandable • respond to needs of the patient • predetermine time of talk • be onest (synchronization of the words and body language) • use silence • repeat last words of the patient • use paralingvistic sounds …hmm… eh.. • don’t speak about yourself • avoid mentor’s position • be careful if you feel helpless . It is easy to make a mistake • first talk to the patient, secondary -to the family • talk to the family over open door • Never say: • Everybody dies • You may have another child, (when the one died)

  17. Communication with children: • The evidence does suggest that those families who can express themselves openly benefit both during the child`s illness and after the death. / Spinetta et al. 1981 / • The consensus opinion in the literature has moved over the last 20 years from a protective approach to children towards honesty and openness / Chesler 1986 / • Many acquire considerable information about their disease , including the possibility of death, without being told specifically. This happened even to children who were cared for by staff and parents who were cared for by staff and parents who believed that the children would remain naive and protected if their disease was not discussed with them. / Bluebond-Langer 1978, Kendrick et al. 1987/ • Even experienced staff who overtly expressed the wish to be open, have been observed to use distancing tactics regularly. / Maguire 1985/

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