COUNSELLING, BEREAVEMENT &

BREAKING BAD NEWS

Supervisor: Dr Hasliza
Presenters:
Izyan Irdina
Arief
Abdullah
Outlines
◦ COUNSELLING
- STRATEGY IN COUNSELLING
- FAMILY PLANNING COUNSELLING

◦ BEREAVEMENT
- 4 STAGES OF BEREAVEMENT
- COPING WITH BEREAVEMENT

◦ BREAKING BAD NEWS

-DEFINITION
-BAD NEWS IN OBSTETRICS
-STEPS OF BREAKING BAD NEWS (SPIKES MNEUMONIC)
Counselling
o Can be defined as ‘the therapeutic process of helping a patient to explore the nature of his or
her problem in such a way that he or she determines his or her decisions about what to do’.
o Basic of counselling:
◦ Had good rapport with the patient
◦ Good listening skill
◦ Empathy (ability to put oneself into another’s shoes)
◦ Good communication skills
◦ Always aware of family context
◦ Maintain good eye contact
◦ Confidentiality is essential
Key Strategies in
Counselling
GATHER approach
◦ G = Greet patient in a friendly, helpful and respectful manner
◦ A = Ask patient about needs, concerns and previous use
◦ T = Tell patient about different options and methods
◦ H = Help patient to make decision about choice of method she preferred
◦ E = Explain to patient how use the method
◦ R = Return: schedule and carry out return visit and follow-up of patient
Family Planning Counselling
The role of family planning counselling is to support a woman and her partner in
choosing the method of family planning that best suits them and to support them in
solving any problems that may arise with the selected method.

During late pregnancy, postpartum or after abortion, it is important that the woman or
couple receives and discusses correct and appropriate information so that they can
choose a method that suits their needs.
Family planning counselling by
GATHER approach
 Important questions to expect
◦ Can the method be used while breastfeeding?
◦ How effective is it?
◦ Are there any side effects?
◦ Does it provide protection from STIs or HIV?
◦ Does it impact on sexual relations?
◦ How easy it is to use?
◦ Is it easy to stop using the method?
◦ Is the method reversible?
◦ How quickly will fertility return once method is stopped?
◦ Is it used contionuously or used only when needed?
Providing useful information on the
chosen method
◦ What the method is and how it works
◦ How effective it is at preventing pregnancy
◦ Side effects- what to expect and what to do about them
◦ How to use the method correctly
◦ What to do in case of a mistake in the use of the method (eg. Missed pills, late for injection, condom
splits)
◦ Information on when to return to the clinic
◦ Signs of complications to watch out for
◦ The best way to check whether a woman knows how to use the method is to ask her to explain to you in
her own words on how to use the method.
BREAKING BAD NEWS
Breaking Bad News

Bad News are any news that drastically and negatively alters the patient's
view of their future.

How bad news affect patients?

 Adversely affects view of future

 Feeling of lost of hope

 Damage mental well being – stress, sadness

 Upset/limit an established lifestyle

Example of O&G cases where Breaking
News Skill is needed
• Miscarriage
• Intrauterine Death
• Stillbirth
• Chromosomal Abnormality
• Malignancy
Aims in Delivering Bad News

1. Provide all parties with the relevant information about the clinical
situation
2. Allow patient have emotional reactions
3. Involve the patient in decision making process
4. Positively respond to the patients reaction;
in order to best equip patient to deal with stress created
5. Involve all the relevant parties;
parent, spouse, family members
6. Provide patient with the management options/plans
What is out strategy?
S - SETTING Up The Interview

◦ Arrange for a quiet place with privacy

◦ Limit interruptions
◦ Involve relevant parties
- patient, spouse, family
- MDT
◦ Preferred body positions
- Sitting while speaking
- Open posture
- Eye contact
P- Assessing The Patient’s PERCEPTION
◦ Aim to assess patient’s knowledge, expectations and hopes
◦ Use open-ended questions to create a accurate picture of how the patient
perceives the medical
Assessment of:

1. What the patient/family understand about the situation?

(ie. Why was patient admitted/investigations carried out/finding)

2. What this news will mean to them in the context of the illness?

3. What do they want to know?

I – Obtaining The Patient’s INVITATION
◦ Aimed to assess how much does the patient want to know
◦ Most patients will indicate that they want full information
◦ We alter our approach according to the patient’s preference

Example:
How would you like me to give the information about the test results?

Would you like me to give you all the information or sketch out the
results and spend more time discussing the treatment plan?
K- Giving KNOWLEDGE And Information
◦ Breaks the news

◦ First, fire a Warning shot

- “Unfortunately, I've got some bad news to tell you”
- “I'm sorry to tell you that…”

◦ Try to use simple language

K- Giving KNOWLEDGE And Information
Focus on a Patient-centered discussion
◦ Avoid jargons (“spread” vs “metastasized”)
◦ Avoid excessive bluntness
◦ Give information in small chunks

Allow for pause, allow information to sink in

Wait for response before continuing

Periodically check patient’s understanding

E – EMPATHETIC response to emotions

◦ Patient may respond with a wide range of emotions;

- silence, disbelief/denial, sobbing, dramatic crying, anger

◦ Empathetic response:
- Observe for patient’s response
- Identify the emotion (by naming it )
- Identify reason of emotion

◦ Offer empathic responses

Give patient time to express their feelings

S- STRATEGY And Summary

◦ Aimed to allow discussion about the management plan

◦ Ask if the patient are ready for discussion regarding future treatment plan

◦ Provide patient with management option

◦ Clarify any misunderstandings

- prevent patients from misunderstanding the purpose of ­treatment /
misunderstanding the efficacy of treatment
 Reference
1. Todd A. Swanson M.D. PhD, Sandra I. Kim MD PhD, Nadeem N. Hussain . Underground Clinical
Vignettes Step 1: Behavioral Science (Underground Clinical Vignettes Series), 5th ed. :
Lippincott Williams & Wilkins; 2007.
2. Walter F. Bailea, Robert Buckmanb, Renato Lenzia, Gary Globera, Estela A. Bealea and Andrzej
P. Kudelkab. SPIKES—A Six-Step Protocol for Delivering Bad News: Application to the Patient
with Cancer.