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TWA-17052018 Breaking Bad News (SPIKE)
TWA-17052018 Breaking Bad News (SPIKE)
BAD NEWS
Let your light shine. Be the source of strenght and
courage
Foundation :
Patient-Centered Care
Soul
Principle of
non • Requires that health professionals ‘do no
harm’, they avoid or minimize harm to patient
maleficience
Ethical Problem of Telling the Truth in Breaking
Bad News
Improve wellbeing
Improve the Quality
(Emotional &
of Life
Spiritual)
Increase
Promote comfort adherence to
doctor’s advice
Please...feel sensitive with
your patient’s symptoms
• General Weakness
- Fatique
• Pain
- Common, complex
• Respiratory Symptoms
- Shortness of breath, coughing, wheezing
• Gastrointestinal Symptoms
- Nausea, constipation, pressure ulcer
• Psychological Symptoms
- Depression, delirium, anxiety
From Johnson DC, Kassner CT, Houser J, Kutner JS. Barriers to effective symptom
management in hospice. J Pain Symptom Manage 2005;29:69-79 .
Stages of Grief-DABDA
(Kubler-Ross, 1969)
• Denial
• Anger
• Bargaining
• Depression
• Acceptance
Maslow’s Hierarchy of Patient with Advance Disease
Nuclear needs of patients
1. Spiritual
2. Dignity
3. Realistic hope
4. Respect
How to break bad News with “SPIKES”
(Buckman, 1992)
• Warning the patient that bad news is coming may lessen the shock
that can follow the disclosure of bad news and may facilitate
information processing
• Example of warning shot: “Maaf ibu, saya harus mengatakan bahwa hasil
pemeriksaan darah dan sumsum tulang ibu ini tidak begitu baik (pause-diam
sejenak)....kami menemukan ada sejenis kelainan darah”
• Giving medical facts but try to use too much nontechnical words (avoid
medical jargon) like biopsi, metastase jauh etc.
• When the prognosis is poor, avoid using phrases that indicated
pessimism such as “Kami menyerah....kami sudah tidak bisa berbuat
apa apa lagi”
Explore Emotions and Emphatize
• Patients who have a clear plan for the future are less likely
to feel anxious and uncertain.
• Before discussing a treatment plan, it is important to ask
patients if they are ready at that time for such a discussion.
• Presenting treatment options to patients when they are
available is not only a legal mandate in some cases , but it
will establish the perception that the physician regards their
wishes as important.
Another Concept of Breaking Bad News
ABCDE
• Advanced Preparation
• Build a therapeutic environment
• Communicate well
• Deal with patient and family reactions
• Encourage and validate emotions