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

    Step 2. Finding out What the Patient Knows Step 3. Finding out How Much the Patient Wants to Know

    Step 2. Finding Out What the Patient Knows

    What to Ask

    • Start the discussion by establishing what the patient and family know about the patient’s health
    • With this information, ascertain if the patient and family will be able to comprehend the bad news
    • Questions might include:
      • "What do you understand about your (your child’s) illness?"

      • "How would you describe your medical situation?"

      • "Have you been worried about your illness or symptoms?"

      • "What did other doctors tell you about your condition or any procedures that you have had?"

      • "When you first had symptom X, what did you think it might be?"

      • "What did Doctor X tell you when he sent you here?"

      • "Did you think something serious was going on when…?"


    When the Patient Seems Unprepared

    • Occasionally a patient (or a parent if the patient is a child) will fall silent and seem completely unprepared or unable to respond
    • To ease the situation and stimulate discussion
      • Try to clarify what the patient understands about his or her medical history and recent investigations

      • Identify absent family members or others on whom the patient relies
    • Consider rescheduling the meeting for another time...
      • If the efforts described above seem ineffective

      • If the patient remains silent

      • If it appears the patient requires more support
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