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L/O/G/OTipsforBreakingbadnewsACriticalclinicalskillProf.MervatAtfyMohamedZagagaziguniversityhospital:*Recognizechallengetosharebadnewseffectively*Beabletodescribeaneffectivelysixstepsprocesstosharebadnews-SPIKES.ApplicationtothePatientwithCancerBecommittedtoimprovingyour*skillsinbreakingbadnewstopatientLearningobjectives:*Helpthepatientandfamilyunderstandthecondition*SupportpatientandFamily*MinimizeriskofoverwhelmingdistressGoals*Thephysicianperspectivehighdegreeofdifficult+physiciananxiety=Highriskofperformingpoorly.Whenphysiciansareuncomfortableingivingbadnewstheymayavoiddiscussingdistressinginformation,suchasapoorprognosisWhyitiscriticalskill?Whyitiscriticalskill?*MoretimetotalkandshowfeelingsFromDoctorsMoreinformation,caring.Confidence,hopefulness,FamiliarfaceWhatdopatientswant?SixstepProtocolForbreakingbadApplicationtothePatientwithCancernews::SettingupTheinterview*Privatesetting,sittingdown*Notelephone,turnoffmobile,nointerruptions*Ensureadequatetime*Reviewthecondition,lab,basicprognosisandtreatmentbeforevisit*Hopefultone—ASSESSINGTHEPATIENT'SPerceptionbeforeyoutell,ask.*Assessthegapbetweenwhatthepatientknowsanddiagnosis.*Whathavebeentoldaboutwhataregoingon?*WhatisyourunderstandingwhytheCTscanwasordered?MervatatfymohamedSTEP2:P—ASSESSINGTHEPATIENT'SPerception—OBTAININGTHEPATIENT'SInvitation:K—GIVINGKNOWLEDGEANDINFORMATIONTOTHEPATIENT“orI'msorrytotellyouthat....STEP4:K—GIVINGKNOWLEDGEANDINFORMATIONTOTHEPATIENT•Trytousenontechnicalwordssuchasspreadinsteadofmetastasizedand•sampleoftissueinsteadofbiopsy.(e.g.,Youhaveverybadcancerandunlessyougettreatmentimmediatelyyouaregoingtodie.)asitislikelytoleavethepatientisolatedandlaterangry,withatendencytoblamethemessengerofthebadnewsBalancedtruthandHope:skillfuluseofindirectlanguageAs(itislooklike)not(youhave…..(Therearetumoursintheliver)not(youhavetumorinyourliver:E—ADDRESSINGTHEPATIENT'SEMOTIONSWITHEMPATHICRESPONSES*Observeforandallowallemotionalreaction*UsetouchNamethefeelings…..Iknowthisisupsetting……..itwouldbeforanyoneUnderstanding…….youareaskingalltheRightquestions—Summaryandstrategyforfollowup