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BREAKING BAD NEWS IIT FITRIANINGRUM DEPARTEMEN BIOETIKA DAN HUMANIORA PRODI PENDIDIKAN DOKTER FK UNTAN
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3. k. Breaking Bad News (Dr. Iit)

Feb 03, 2016

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Page 1: 3. k. Breaking Bad News (Dr. Iit)

BREAKING BAD NEWS

IIT FITRIANINGRUMDEPARTEMEN BIOETIKA DAN

HUMANIORA PRODI PENDIDIKAN DOKTER FK UNTAN

Page 2: 3. k. Breaking Bad News (Dr. Iit)

Breaking Bad News/EBP3KH TA.2014/2015

Tidak seorangpun menyukai mendengarkan

berita buruk, walaupun dokter dan professional lainnya selalu memiliki berita buruk :

Penyakit kronik meningkat Mempertinggi pentingnya mengerti

bagaimana menyampaikan berita buruk mempengaruhi pasien, keluarganya, dan dokter/tenaga medis lainnya

BACKGROUND

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Berita buruk dapat berarti different things to different

people Berita buruk adalah “setiap informasi, yang mana

adversely dan dampak serius bagi masa depan individu”

The impact cannot estimate until one has first determined the recipient’s expectations or understanding

Ex: pasien dengan kanker payudara who is told that her back pain is caused by recurrence of her breast cancer will be most likely to be shocked due to her expectation to be told it was muscle strain

What is Bad News?

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Cemas for causing and adverse event (stress, marah, anxiety) Anxiety from the patient increase when patient were given the

bad news (Lienard et al, 2006) Other studies showed that when reported about bad news, 54%

will shock, 46% will frigth, 24% akan sedih, 40% akan menerima dan hanya 15% that wont worry (Whippen and Cannelos, 1991)

Worry that will be difficult to handle the reaction of patient & their family

Barnett (2002) found that when patient given the doctor about bad news, 49% will neutral, 20% will have positive perception, 20% will negative perception, 6% will have a very negative perception on doctor

People will most likely not remember about the information (Eden, 1994)

Why It is Hard to explain bad news to the patient?

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Setting up the interview Perception of the patient Invitation by the patient Knowledge to the patient Emotions of the patient Strategy and summary

How to Inform the Bad News to Patient?

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Arrange for privacy Involve significant others“ is there anyone you would want to have present when we talk” Duduk Make connection with the patient Manage time constraints and interruption

Setting up the interview

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Sebelum diberitahu, ask (ask about his/her view of the

situation)

“what have you been told about your condition so far?”“How much do you understand about what is going on medically?”“what is your understanding of why we did the MRI?” Can determine if patient is in denial Can determine unrealistic expectations of

treatment

Perception of the Patient

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Majority of patients express a desire for full

information Discuss Information disclosure while ordering test“ How would you like me to give the information about the test results”“Are you the kind person who likes lots of detail, or would you prefer big picture? If patient does not want to know details, offer to

answer any questions they may have or involve a relative or friend

Invitation by the patient

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Give a warning shot“Unfortunately, I have some bad news to tell you....”“I’m sorry to tell you that...” Start at level of compherension of the patient Use nontechincal words “spread” instead of

“metastasized” Avoid being blunt as it may make the patient

isolated and angry “You have such bad cancer that you will nots surveive without treatment...”

Knowledge to the patient

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Give information in small amounts, then

periodically check the patient’s understanding“ I’ve given you a lot of information. What are your reaction and concerns at this point?” When the prognosis is poor, avoid using

phrases that inconsistent with other important theraupetic goals

“ There is nothing more we can do for you” The fact is that we have another goals such as good pain control and symptom relief

....Knowledge to the patient

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Respond to the patients emotions with

emphaty Often shock, isolation, disbelief, grief or anger Observe for emotion on patient’s part Identify emotion Identify the reason for the emotion Connect with patient

Emotions of the patient

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Doctor : “I’m sorry to say that the X-ray shows

that the chemotherapy is not working [pause]. Unfortunately, the tumor has grown somewhat”

Patient : “I’ve been afraid of this!” [cries] Doctor : [moves his chair closer, offers the

patient a tissue and pauses,] “I know that this isn’t what you wanted to hear. I wish the news were better”

...Emotions of the patient

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Continue to make emphatic responses until

the patient becomes calm Emphatic statements I can see how upsetting this is to you I can tell you were not expecting to hear this I know this is not good news for you I’m sorry to have to tell you this This is very difficult for me also I was also hoping for a better result

...Emotions of the patient

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When emotions are not clearly expressed, the

physician should ask question before makes an emphatic response

Exploratory questions How do you mean? Tell me more about it You said it frightens you You said you were concerned about your

children, tell me more Could you tell me what you are worried about?

...Emotions of the patient

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Validating responses I can understand how you felt that way I guess anyone might have the same reaction You are perfectly correct to think that way Your understanding of the reason for the tests is

very good Many other patients have had similar experience It will reduce patient’s isolation and validate the patient’s feelings/thoughts as normal and to be expected

...Emotions of the patient

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Patients who have a clear plan for the future are

less likely to feel anxious and uncertain Ask if patients are ready to discuss this Clinicians are often uncomfortable doing this

especially in unfavorable prognosis Explore patients’ ICE (ideas, concerns and

expectations) Understand specific goals patient may have like

symptom control and pain relief Give hope in terms of what is possible to

accomplish

Strategy and Summary

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Falsehood is so easy, truth is so difficult

(George Elliot)

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Dua pasien dibawa ke UGD dengan mobil polisi. Mereka berdua

adaah suami istri yang mengalami kecelakaan lalu lintas. Karena trauma yang parah, sang suami setelah diupayakan tindakan penyelamatan jiwa tidak dapat terselamatkan

Sang istri dalam keadaan sadar dan tengah dirawat di ruangan yang lain yang berbeda. Karena terjadi perdarahan dan trauma pada beberapa organ vital di dallam rongga thorax dan abdomen, dokter Sp.B memutuskan untuk segera melakukan operasi

Ketika saudara mempersiapkan pasien tersebut untuk dioperasi, pasien tersebut bertanya kepada saudara mengenai keadaan suaminya, “Bagaimana keadaan suami saya dok? Apakah dia juga harus dioperasi? Saya ingin bertem dengan dia sebelum saya dioperasi!’

Jika saudara adalah dokter yang merawat pasien ini, apa yang akan saudara katakan kepada pasien tersebut

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