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  • Introduction
  • 1. Advance Care Planning
  • 2. Communicating Bad News
  • 3. Whole Patient Assessment
  • 4. Pain Management
  • 5. Assisted Suicide Debate
  • 6. Anxiety, Delirium
  • 7. Goals of Care
  • 8. Sudden Illness
  • 9. Medical Futility
  • 10. Common Symptoms
  • 11. Withholding Treatment
  • 12. Last Hours of Living
  • 13. Cultural Issues
  • 14. Religion, Spirituality
  • 15. Legal Issues
  • 16. Social and Psychological
  • More About:

  • Hospice Care
  • Clergy and Faith Communities
  • Additional Links
    Site Index
    Back to Module 2: Communicating Bad News
    A Six Step Protocol

    Step 1. Getting Started

    Step 2. Finding out What the Patient Knows

    Step 1. Getting Started

    Planning What to Say

    • Before starting to communicate any news, plan what will be discussed
    • Confirm the medical facts of the case
    • Ensure that all the needed information is available
    • If this is an unfamiliar task, rehearse what you will say
    • Don’t delegate the task

    Creating a Conductive Environment

    • Ensure privacy and adequate seating
    • A box of facial tissues should be handy
    • For pediatric patients, have staff available to be with the child while information is conveyed to the parents, first

    Alloting Adequate Time

    • Do not slip this into a short interval between other critical tasks
    • Prevent interruptions
    • Arrange to hold telephone calls and pages

    Determining Who Else the Patient Would Like Present

    • Individuals the patient may wish to have present for the discussion include:
      • Family
      • Significant others
      • Surrogate decision-makers
      • Key members of the interdisciplinary team (nurse, social worker, chaplain, etc)
    • For pediatric patients, include parents
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