Communicating Bad News

2019 ◽  
pp. 114-117 ◽  
Author(s):  
Meaghann S. Weaver ◽  
Michaela Ibach
Keyword(s):  
Palliative Care ◽  
Healthcare Workers ◽  
Bad News ◽  
Care Providers ◽  
Communication Tools ◽  
Family Meeting ◽  
Humanitarian Crises ◽  
Health Related

This chapter examines several strategies for conveying bad or challenging health-related news in a variety of situations. Principles discussed in this chapter are applicable to healthcare workers across all disciplines but are especially useful for palliative care providers and those working in humanitarian crises or emergencies. The SPIKES protocol and the Ask-Tell-Ask method communication tools are reviewed in detail with both positive and negative examples provided to aid the reader in application. Recommendations for setting up a family meeting, exploring patients’ goals, arranging follow-up, and responding to emotion are also included.

Evaluation of coordination of cancer care between designated cancer hospitals and primary care providers: Results from a nationwide survey in Japan.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 84-84
Author(s):  
Taro Tomizuka ◽  
Tomone Watanabe ◽  
Satoru Kamitani ◽  
Takahiro Higashi
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
Care Coordination ◽  
Cancer Care ◽  
Critical Path ◽  
Primary Care Providers ◽  
Care Providers ◽  
Follow Up Care ◽  
Cancer Specialist

84 Background: To improve coordination of cancer care between cancer specialist hospitals and primary care providers (PCPs), the Japanese government accredited cancer specialist hospitals, so called “designated cancer care hospitals (DCCHs)” and introduced “Cancer care coordination instruction fee” which PCPs can receive if they share a cancer critical path (Japanese version of Survivorship Care Plans) of each cancer patient with DCCHs. We sought to assess the current status of coordination of cancer care in Japan and communication between DCCHs and PCPs from PCPs’ point of view. Methods: A cross-sectional mail survey was administered to randomly selected clinic-based PCPs (4,000 clinics) from a nation-wide database of medical institutions authorized by Ministry of Health, Labour and Welfare Japan to treat patients with health insurance (87,869 clinics). The survey evaluated how much PCPs provided cancer follow-up care and how well DCCHs coordinated care and communicated with PCPs in cancer survivorship. Results: 1,873 PCPs returned the questionnaire (response rate: 46.8%). 1,223 (65.3%) answered to provide cancer follow-up care in outpatient setting. Most of the PCPs which provided cancer follow-up care evaluated the care coordination and support by DCCHs were satisfactory (946, 77.4%) but the degree of good evaluation varied by region (highest: 91.3%, lowest: 45.8%). In regression analysis, provision of palliative care by PCPs (OR 1.52 95%CI 1.05-2.17) and use of cancer critical path (OR 2.10 95%CI 1.63-2.71) were significantly correlated with better evaluation of communication and care coordination. Conclusions: DCCHs communicated well with PCPs and PCPs were satisfied with the communication and care coordination by DCCHs. Provision of palliative care by PCPs and use of cancer critical path are likely to lead good care coordination in cancer care.

scholarly journals Palliative Renal Care and the Covid-19 Pandemic

2020 ◽  
Vol 42 (2 suppl 1) ◽  
pp. 44-46
Author(s):  
Cássia Gomes da Silveira Santos ◽  
Alze Pereira dos Santos Tavares ◽  
Carmen Tzanno-Martins ◽  
José Barros Neto ◽  
Ana Maria Misael da Silva ◽  
...  
Keyword(s):  
Palliative Care ◽  
Healthcare Professionals ◽  
Standard Treatment ◽  
Bad News ◽  
Shared Decision ◽  
Communication Techniques ◽  
Relief Of Suffering ◽  
Serious Disease

ABSTRACT Introduction Palliative care is an approach aimed at relieving suffering, controlling symptoms and seeking to improve quality of life. It must be offered in conjunction with standard treatment for any disease that threatens the continuation of life, such as a Covid-19 infection. Discussion The bioethical principles and strategies used by palliative medicine can assist nephrologists in the care of patients with renal dysfunction, who face the difficulties of isolation at the beginning and follow-up of dialysis in outpatient treatment, and those who are at risk for a more serious disease progress. Some of them: - a Shared decision making, which enables the patient and family to participate as facilitators in the systematization of the team’s reasoning, in addition to respecting the principle of autonomy; - Symptom Management: which should be a priority to ensure relief of suffering even in times of social isolation; - Communication skills: making it possible to alleviate suffering in announcing bad news or complex decisions through communication techniques;; - Bereavement assistance: which in acute situations such as the pandemic, causing unexpected losses, the importance of sympathy from healthcare professionals becomes even greater. Conclusion The principles of palliative care are essential to face the challenges of a planet-wide crisis, which raises human suffering in all dimensions, and which requires the construction of strategies that can keep patients assisted, comfortable and with measures proportional to their clinical condition and preferences.

Changing focus: Living with advanced cancer—Development of a palliative care transition project.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 152-152
Author(s):  
Paul Joseph Daeninck ◽  
Simone Stenekes ◽  
Tara Carpenter-Kellett ◽  
Jill Talylor-Brown ◽  
Mark Kristjanson ◽  
...  
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Advanced Cancer ◽  
Health Care Providers ◽  
Care Providers ◽  
Cancer Centre ◽  
Palliative Approach ◽  
Follow Up Care ◽  
Treatment Summary

152 Background: The improvement in cancer screening, detection and treatment is changing the illness trajectory and experience for patients. Many cancer patients are living longer with advanced disease as treatment options have expanded. Thus, accurate prognostication is becoming challenging and referral to palliative care programs is often delayed until close to death. This has made the transition to a predominantly palliative approach to care complex to navigate for the health care team, patient and family. Methods: CancerCare Manitoba has undertaken an innovative project “Changing Focus: Living with Advanced Cancer” to enhance communication with primary health care providers (HCPs) and assist patients and caregivers in the transition to a palliative approach to care. The project includes development of an individualized patient treatment summary that provides details of the patient’s cancer treatment and symptoms, identifies the role of the HCPs involved with the patient and family, as well as the expectations for follow up care at the cancer centre and in the community. The transition appointment includes discussion around the treatment summary, standardized follow up care plan, and written information about palliative care, decision making, symptom management, unique issues for caregivers and details about local supports and resources is provided. Results: This presentation will focus on the development and implementation of this project within the cancer centre and throughout the province. Evaluation of this approach is ongoing. Family members and patients will provide feedback using a standardized questionnaire, and ongoing improvement will be built into the evolution of this program. HCPs will also be engaged in evaluation from their perspective. Conclusions: We expect this intervention will allow patients and families better quality of life and possibly improve the interval between the termination of chemotherapy and death.

scholarly journals Quality of life of community-based palliative care clients and their caregivers

2012 ◽  
Vol 11 (4) ◽  
pp. 323-330 ◽  
Author(s):  
Tanya Connell ◽  
Ritin S. Fernandez ◽  
Duong Tran ◽  
Rhonda Griffiths ◽  
Janeane Harlum ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Physical Symptoms ◽  
Health Related Quality ◽  
Caregiver Quality ◽  
Related Quality ◽  
Health Related ◽  
Matched Data

AbstractObjective:This study aimed to investigate health-related quality of life of palliative care (PC) clients and their caregivers, at baseline and follow-up, following a referral to a community PC service.Method:Quality of life of clients and their caregivers was respectively measured using the McGill Quality of Life instrument (MQoL) and the Caregiver Quality of Life Cancer Index (CQoLC) instruments. Participants were recruited from June 8 to October 27, 2006. This study was undertaken in one zone of an Area Health Service in New South Wales, which has a diverse socioeconomic population. The zone covers an area of 6237 km2 and is divided into five sectors, each with a PC service, all of which participated in this study.Results:Data were obtained from 49 clients and 43 caregivers at baseline, and 22 clients and 12 caregivers at 8 week follow-up. Twenty-one participants died and six moved out of the area during the study. At baseline, clients reported a low mean score for physical symptoms (3.3 ± 1.9) and a high score for support (8.7 ± 1.0). Caregivers scored a total CQoLC of 63.9 ± 21.4 and clients had a total QOL of 6.1 ± 1.3. At follow up, matched data for 22 clients and 13 caregivers demonstrated no statistical differences in quality of life.Significance of results:This study has provided evidence that health-related quality of life questionnaires show lower scores for physical health and higher scores for support, which can directly inform specific interventions targeted at the physical and support domains.

Palliative care in catastrophic disasters and humanitarian crises

2021 ◽  
pp. 1020-1026
Author(s):  
Anne Wilkinson ◽  
Marianne Matzo
Keyword(s):  
Palliative Care ◽  
Vulnerable Populations ◽  
Care Delivery ◽  
Disaster Medicine ◽  
Care Services ◽  
Dying Patients ◽  
Humanitarian Crises ◽  
Health Related ◽  
Palliative Care Services ◽  
Negative Impacts

Both catastrophic disasters and humanitarian crises can have widespread, long-term, and often unpredictable negative impacts, causing shortages of safe water, food, shelter, transportation, and sanitation as well as the displacement of large numbers of people and the loss of many lives. Routinely ignored in disaster and humanitarian planning are those socially and medically vulnerable populations living in the affected community who are dependent on the existing healthcare system for survival, making them particularly predisposed to the risk of harm or death due to the event. Because of their unique needs, extra steps need to be taken in order to reduce the likelihood that vulnerable populations will suffer injury, disease, or even death. Serious health-related suffering resulting from illness or injury stemming from a natural or man-made crisis could be ameliorated by the inclusion of palliative care services in planning and response activities. While the primary goal of disaster medicine is to maximize the number of lives saved and to ensure the best outcomes for the community as a whole, a holistic and fully compassionate response necessitates a secondary goal of minimizing the physical and psychological suffering of those whose lives may be shortened by a crisis event. In order to effectively provide palliative care services in crisis situations, all care delivery sites, especially triage and alternative care sites, will need clearly articulated protocols, trained staff (including personnel with palliative care, mental health, and spiritual counselling skills), supplies (including those necessary for appropriate pharmacological treatment), and appropriate space for dying patients.

Outcomes of an Integrated Urology-Palliative Care Clinic for Patients With Advanced Urological Cancers: Maintenance of Quality of Life and Satisfaction and High Rate of Hospice Utilization Through End of Life

2019 ◽  
Vol 36 (9) ◽  
pp. 801-806 ◽  
Author(s):  
Kathy Huen ◽  
Cher Huang ◽  
Hui Liu ◽  
Lorna Kwan ◽  
Stephanie Pannell ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Short Form ◽  
Health Related Quality ◽  
Care Clinic ◽  
Urological Cancers ◽  
Related Quality ◽  
Health Related

Introduction: Systematic integration of palliative care in a surgical setting is important, but has yet to be achieved. Despite evidence of early palliative care improving patients’ quality of life, hospice utilization remains low. Through an integrated palliative care-urology clinic, we aim to assess the effect of early outpatient palliative care on hospice utilization, health-related quality of life (HRQOL) and satisfaction in patients with advanced urological cancers. Methods: Participants were recruited from 2012 through 2016 in the Greater Los Angeles Veterans Affairs Hospital. We partnered with palliative care clinicians to develop an integrated urology-palliative care clinic, where participants were seen by the palliative care team on the same day as their urological visit. The 12-item Short-Form Survey, Patient Satisfaction Questionnaire Short-Form, Patient Health Questionnaire, and Brief Pain Inventory were administered at initial and subsequent visits. Follow-up questionnaire results were compared between baseline and the 2 follow-up visits, and hospice utilization rates were assessed. Results: Fifty-three participants completed baseline questionnaires. Of those 22 (42%) patients completed at least one follow-up assessment. The median time for the first and second follow-up visits was 2.9 and 7.8 months, respectively. There were no significant differences in HRQOL and satisfaction between baseline and subsequent follow-up visits. A total of 36 (68%) of 53 participants who were enrolled at the start of the study were deceased. Of those, 29 (81%) expired within a home or inpatient hospice. Conclusions: Rates of hospice use were high in an integrated palliative care-urology model. Health-related quality of life and satisfaction did not worsen over time.

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