HOW TO COMMUNICATE BAD
NEWS EFFECTIVELY AND STAY
HUMAN AS A PROFESSIONAL JULIA SAMUEL
ALL TOGETHER BETTER HEALTH V111 OXFORD 6-9 SEPTEMBER
COMMUNICATING BAD NEWS EFFECTIVELY
AND STAYING HUMAN AS A PROFESSIONAL
Julia Samuel
Founder Patron
Child Bereavement UK
ALL TOGETHER BETTER HEALTH V111
OXFORD 6-9 SEPTEMBER
ATBH VIII
8th September 2016
WHEN MEDICINE FAILS
HUMANITY IS KEY
WHEN MEDICINE FAILS
IT IS OUR HUMANITY
THAT HAS TO REACH OUT
ATBH VIII
8th September 2016
IN WORKING WITH
GRIEVING FAMILIES
WE ALL BRING OUR OWN:
Beliefs and values
Hurts and losses
Feelings about death
Desire to care for others
Ability to reach out and be involved
Inability, when overpowered by the horror or
tragedy of death and our own emotions
ATBH VIII
8th September 2016
When bad news is delivered poorly the
experience may stay in a patient’s or family’s
mind long after the initial shock of the news has
been dealt with.
study;
Holland, JC. 1989
ATBH VIII
8th September 2016
LISTENING TO INDIVIDUAL
NEEDS OF THE FAMILY
Parents Say
“Parents are the ones who know their children best.
It is impossible for professionals to have the insight
necessary to help, if they don’t listen.”
“We adore our child, appreciate what he is capable of and
have acted in his best interests without worrying which
professionals we upset in the process. If they can’t see
the child instead of the label, it’s their problem, we’ll go
elsewhere.”
study;
Mencap: 2008
Contact A Family: 2009
ATBH VIII
8th September 2016
FAMILIES NEED:
Information
Guidance
Family support
To be themselves
study;
Murray Parkes. 2001
ATBH VIII
8th September 2016
HOW TO COMMUNICATE BAD NEWS?
PREPARE FOR THE DISCUSSION
Establish what the patient and family know
Determine how information is to be handled
Deliver the information
Respond to emotions
Establish goals for care and treatment priorities
Establish a plan
study;
Von Gunten et al: 2001
ATBH VIII
8th September 2016
PARENTING
DOESN’T STOP...
“When I stood at the hospital door, it
was the hardest thing of all, to leave
him there, on his own. I felt as though
I was leaving him when he was
needing me most. I wondered if he
was lonely.”
ATBH VIII
8th September 2016
Underlying fear of self-disintegration
VULNERABLE INVULNERABLE TOTALLY
VULNERABLE
Potentially constructive and
helpful to patients &
ourselves
Underlying illusion of own
importance - strives to achieve
‘perfect death’,
‘knows’ all patients needs
The ‘perfect’ care provider
Relation with Others
Low permeability
High boundaries
Alienation from other
Relation with Self
Unaffected by experience
Unable to process loss and grief
Relation with Others
Displays empathy
Develops symbiotic relationship with
other Adapts/fails to adapt to needs of
others
Relation with Self
Accepts personal strengths and
limitations
Able to process impact of loss and
grief
The ‘good enough’ care provider
Relation with Others
High permeability
Low boundaries
Destructive identification with other
Relation with Self
Overwhelmed by experience
Unable to process loss and grief
The ‘ineffective’ care provider
ATBH VIII
8th September 2016
AUTONOMIC
NERVOUS SYSTEM:
Arousal response:
Sympathetic
Wind down response:
Parasympathetic
ATBH VIII
8th September 2016
AT WORK:
AIMS OF DEBRIEFING
Safe place to express feelings
Recognise and release emotions
built up during event
Mistakes part of learning process
Extends limited picture of what happened
during the event, while involved they only
observe those parts their position allows
them to
Identify resources, limits, strengths
study;
Gibbs, G: 1988
ATBH VIII
8th September 2016
Description what
happened?
What were your
feelings and how
did you react?
Initial evaluation
of the experience
what was good and
bad about it? Critical analysis
what sense did you
make of the
experience
Final evaluation
and action plan
what would you do
differently
Conclusion what
have you learnt from
reflecting on
this experience?
ATBH VIII
8th September 2016
Keystone Habits
Cue-Reward-Routine
Location /Time /Emotional State/ Other People /Pattern
Charles Duhigg
www.powerofhabit.com
THE POWER OF HABIT:
ATBH VIII
8th September 2016
THE POWER OF HABIT:
DON’T ASK YOURSELF THE QUESTION
J.F.D.I.
study;
Charles Duhigg: www.powerofhabit.com
ATBH VIII
8th September 2016
SELF CARE:
EXAMPLES OF
STRATEGIES FOR SELF
CARE 1. Understanding our own emotions
2. Accept and recognise your need for support,
both practical and emotional
3. Be aware of what support is available to you – establish who
can provide this regular supervision support
4. Journal
5. Exercise
6. Relaxation
7. Clarity about boundaries of our role
– time management
8. Self Compassion
9. Nutrition
10. Ways to relax mind and body
11. Life outside work
ATBH VIII
8th September 2016
REFERENCES
BREAKING BAD NEWS EFFECTIVELY
AND STAYING HUMAN AS A DOCTOR
Aiming high for disabled children:
better support for families
Bluebond-Langner, M. (1989). Worlds of
dying children and their well
siblings. Death Studies,13 1-16.
Bluebond-Lngner , M. (1987) The Private
Worlds of Dying Children Princeton
Universiry Press
Dept. of Education & Skills and HM
treasury 2007
Breaking Bad News- Regional Guidelines:
Partnerships in Caring (2000) DHSSPS
February 2003
Buckman R. (1992) Breaking Bad News:
A Guide for Health Care Professionals.
Baltimore: Johns Hopkins University
Press.
Children with terminal conditions A guide
for donors and funders Valuing Shortlives-
New philanthropy Capital
Dent, A. & Stewart, A. (2004) Sudden
Death in Childhood: support for the
bereaved family Edinburgh:Butterworth
Heinemann
Doka. K.J.E.(1989) Disenfranchised
grief:recognizing hidden sorrow Lexington Books
Doka, K. (1996) Living with grief after sudden loss.
New York: Routledge.
Davis H (1991) Breaking Bad News. Practitioner
235: 522-526
Fallowfield L. (1993) Giving Sad and Bad News.
The Lancet. 341: 477-478
Gilbert, K. R. (1996). “We’ve had the same loss,
why don’t we have the same grief?” Loss and
differential grief in families. Death Studies, 20, 269-
283.
Hoy AM (1985) Breaking Bad News to Patients.
British Journal of Hospital Medicine. 34: 96-99.
Holland JC. (1989) Now We Tell - But How Well.
Journal of Clinical Oncology. 7:557-559
Kubler Ross, E 1974 Journal of Marital and Family
Therapy
Murray Parkes, C. 2001 Bereavement: Studies of
grief in adult life
Maguire P (1985) Barriers of Psychological Care to
the Dying. British Medical Journal 291:1711-1713
Prigerson HG, Vanderwerker LC,
Maciejewski PK. Complicated Grief as a
Mental Disorder: Inclusion in DSM.
Chapter 8 in Handbook of Bereavement
Research and Practice: 21st Century
Perspectives, Eds. Margaret Stroebe,
Robert Hansson, Henck Schut, and
Wolfgang Stroebe, American
Psychological Association Press, 2007
Tesser A, Rosen S, Tesser M. (1971) On
the Reluctance to Communicate
Undesirable Messages (the MUM effect) A
field study. Psychol Rep. 29: 651-654
Vickio, C.J. (1999). Together in spirit:
Keeping our relationships alive when
loved ones die. Death Studies, 23, 161-
175.
Von Gunten et al 2001, The Development
of Breaking bad news, best practice,
Nursing Times
What makes my family stronger –Contact
a Family
Worden, J.W. (2006). Children and
grief. New York: The Guilford Press
Gibbs, G: 1988
www.childbereavement.org.uk
ATBH VIII
8th September 2016
Action for Happiness
www.actionforhappiness.org
Ben Shahar, Tal 2011 Happier Learn
the Secrets to Daily Joy and Lasting
Fulfillment
BMA, May 2007 The Health of Doctors
– Evidence
British Psychological Society, 2008
Psychological Debriefing
Damasio, A, 1999 The Feeling of What
Happens:
Body, Emotion and the Making of
Consciousness Heinemann: London
Damasio, A 1999 The Feeling of What
Happens:Body Emotion and the
Making of Consciousness Harcourt
Brace
Dept. of Health 2005 When a Patient
Dies
Duhigg, C. (2014) The Power of Habit
Turtle Books
Gibbs 1998, Reflection Model
Kabat-Zinn, Jon 2012 Mindfulness for
Beginners: Reclaiming the Present
Moment-and Your Life Sounds True,
Colorado
Aiming high for disabled children:
better support for families
Bluebond-Langner, M. (1989). Worlds of dying children and their well siblings. Death
Studies,13 1-16.
Bluebond-Lngner , M. (1987) The Private Worlds of Dying Children Princeton Universiry
Press
Dept. of Education & Skills and HM treasury 2007
Breaking Bad News- Regional Guidelines: Partnerships in Caring (2000) DHSSPS
February 2003
Buckman R. (1992) Breaking Bad News: A Guide for Health Care Professionals.
Baltimore: Johns Hopkins University Press.
Children with terminal conditions A guide for donors and funders Valuing Shortlives-
New philanthropy Capital
Dent, A. & Stewart, A. (2004) Sudden Death in Childhood: support for the bereaved
family Edinburgh:Butterworth Heinemann
Kabat-Zinn, Jon 2001 Full Catastrophe
Living: How to cope with stress, pain
and illness using mindfulness
meditation Doubleday
Mind.org.uk The Mind Guide: Food
and Mood
Neff, K 2011 Self Compassion W.
Morrow publishers
Paediatric Society 2008: Standards for
Bereavement Care
Pennebaker, James W. (1997)
Opening Up: The Healing Power of
Expressing Emotion. NY: Guilford
Press.
Pennebaker, J.W. (2004)._ Writing to
Heal: A Guided Journal for Recovering
from Trauma and Emotional
Upheaval._ Oakland, CA: New
Harbinger Press.
www.hse.gov.uk/press/2007 Cost of
Workplace Stress and Strategies for
Prevention
REFERENCES
IMPACT OF BEREAVEMENT
ON THE PROFESSIONAL –
STRATEGIES FOR SELF CARE
ATBH VIII
8th September 2016
Action for Happiness
www.actionforhappiness.org
Ben Shahar, Tal 2011 Happier Learn
the Secrets to Daily Joy and Lasting
Fulfillment
BMA, May 2007 The Health of Doctors
– Evidence
British Psychological Society, 2008
Psychological Debriefing
Damasio, A, 1999 The Feeling of What
Happens:
Body, Emotion and the Making of
Consciousness Heinemann: London
Damasio, A 1999 The Feeling of What
Happens:Body Emotion and the
Making of Consciousness Harcourt
Brace
Dept. of Health 2005 When a Patient
Dies
Duhigg, C. (2014) The Power of Habit
Turtle Books
Gibbs 1998, Reflection Model
Kabat-Zinn, Jon 2012 Mindfulness for
Beginners: Reclaiming the Present
Moment-and Your Life Sounds True,
Colorado
Aiming high for disabled children:
better support for families
Bluebond-Langner, M. (1989). Worlds of dying children and their well siblings. Death
Studies,13 1-16.
Bluebond-Lngner , M. (1987) The Private Worlds of Dying Children Princeton Universiry
Press
Dept. of Education & Skills and HM treasury 2007
Breaking Bad News- Regional Guidelines: Partnerships in Caring (2000) DHSSPS
February 2003
Buckman R. (1992) Breaking Bad News: A Guide for Health Care Professionals.
Baltimore: Johns Hopkins University Press.
Children with terminal conditions A guide for donors and funders Valuing Shortlives-
New philanthropy Capital
Dent, A. & Stewart, A. (2004) Sudden Death in Childhood: support for the bereaved
family Edinburgh:Butterworth Heinemann
Kabat-Zinn, Jon 2001 Full Catastrophe
Living: How to cope with stress, pain
and illness using mindfulness
meditation Doubleday
Mind.org.uk The Mind Guide: Food
and Mood
Neff, K 2011 Self Compassion W.
Morrow publishers
Paediatric Society 2008: Standards for
Bereavement Care
Pennebaker, James W. (1997)
Opening Up: The Healing Power of
Expressing Emotion. NY: Guilford
Press.
Pennebaker, J.W. (2004)._ Writing to
Heal: A Guided Journal for Recovering
from Trauma and Emotional
Upheaval._ Oakland, CA: New
Harbinger Press.
www.hse.gov.uk/press/2007 Cost of
Workplace Stress and Strategies for
Prevention
REFERENCES
IMPACT OF BEREAVEMENT
ON THE PROFESSIONAL –
STRATEGIES FOR SELF CARE