Takeaway
When delivering challenging news, it is crucial to tailor the communication to the patient's preferences. Break down the message into small, spaced-out segments to allow for gradual processing.
Connecting with Patients | October 9, 2024 | 2 min read
By Sadiqua Sadaf, MBBS, Deccan College of Medical Sciences, Hyderabad, India & Amy Yu, MD, Johns Hopkins Medicine
An important skill in medicine is delivering challenging news to patients and their loved ones. I found myself reflecting on this when my preceptor, Dr. A, was faced with the task of breaking an unexpected terminal diagnosis to a patient. We walked to the bedside weighed down by the gravity of the information. What unfolded was to be an important lesson for me.
As we entered the room, Dr. A went about ensuring the right setting by bringing in the patient’s family and seating himself at eye level with the patient. He held her hand as the difficult conversation began. “We’ve received the results of your scan. I’m sorry, I come bearing hard news. How much of it would you like me to share right now?” He gave the patient time to process. At this point, I projected my own personal preference and assumed the patient would prefer full disclosure the same as I would.
Holding back tears, the patient said in a shaky voice, “I don’t want you to tell me the details, just tell me how long I have to live.”
To an inexperienced student like me, I thought surely, she needed to know at least some details right away to make an informed decision about the treatment plan.
“How about I break it down and share it with you over the course of a few days? How does that sound? You can let me know whenever you’re ready to hear more,” Dr. A said.
The patient visibly relaxed upon hearing this. Over the next few days, she received a slow feed of information that allowed her enough time to take it all in at a comfortable pace.
Here’s what I learned”
1. Soften the SPIKES.
The SPIKES system of breaking hard news lists out a script for the physician to follow but doesn’t consider patient reaction. I learned it’s important to punctuate each step with deliberate pauses and a gentle tone to soften the blow.
2. Microdose challenging news.
It’s important to ask the patient how much of it they’d like to hear and in what amounts. Breaking the information into pieces allows the patient time and space to make sense of it both cognitively and emotionally.
3. Anticipate anticipatory grief.
Patients dealing with terminal diagnoses are often overcome with grief as they anticipate the many faces of an inevitable loss. As bearers of hard news, it’s important for clinicians to be mindful of this as they devise a plan to share the details of the patient’s prognosis.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.