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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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    Back to Module 2: Communicating Bad News
    A Six Step Protocol

    Step 5. Responding to Feelings Step 6. Planning, Follow-up...

    Step 5. Responding to Feelings

    How do People Respond to Bad News?

    Patients and families respond to bad news in a variety of ways, including affective, cognitive, and psychophysiological responses

    • Affective responses include:
      • Tears
      • Anger
      • Sadness
      • Love
      • Anxiety
      • Relief
    • Cognitive responses include:
      • Denial
      • Blame
      • Guilt
      • Disbelief
      • Fear
      • Loss
      • Shame
      • Intellectualization
    • Basic psychophysiological responses include:
      • "Fight or flight"
      • Leaving the room
      • Withdrawal
    • Parents may become very emotional when thinking about actually telling their child the diagnosis


    What Can the Physician Do?

    Outbursts of strong emotion make many physicians uncomfortable. The following guidelines describe ways to overcome this discomfort and respond in a supportive and helpful way to patients and families as they react to receiving bad news

    15 Ways Physicians Can Help Patients and Families Cope with Bad News:

    1)  Be prepared for a broad range of reactions, including outbursts of strong emotion

      2)  Give the patient and family time to react
      3)  Be prepared to support them through their reactions

      4)  Listen quietly and attentively

      5)  Acknowledge their emotions

      6)  Ask them to describe their feelings:

        "I imagine this is difficult news…"
        "You appear to be angry. Can you tell me what you are feeling?"
        "Does this news frighten you?"
        "Tell me more about how you are feeling about what I just said."
        "What worries you most?"
        "What does this news mean to you?"
        "I wish the news were different."
        "I’ll try to help you."
        "Is there anyone you would like for me to call?"
        "I'll help you tell your son."
        "Your Mom and Dad are sad now. They'll feel better when you get better."
      7)  Remind them that their responses are normal

      8)  Make a box of facial tissue available

      9)  Use nonverbal communication

      10) Consider touching the patient in an appropriate, reassuring manner

      11) Offer a drink of water, a cup of tea, or something else that might be soothing

      12) Allow time for the patient and family to express all of their immediate feelings

      13) Don't rush them

      14) Remind yourself that once the emotion is "spent", most people will be able to move on

      15) Remember that a shared understanding of the news and its meaning will enhance
      the physician-patient relationship and facilitate future decision-making and planning

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