1 / 26

Education in Palliative and End-of-life Care - Oncology

The. EPEC-O. TM. Education in Palliative and End-of-life Care - Oncology. Project. The EPEC-O Curriculum is produced by the EPEC TM Project with major funding provided by NCI, with supplemental funding provided by the Lance Armstrong Foundation.

dstruthers
Télécharger la présentation

Education in Palliative and End-of-life Care - Oncology

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. The EPEC-O TM Education in Palliative and End-of-life Care - Oncology Project The EPEC-O Curriculum is produced by the EPECTM Project with major funding provided by NCI, with supplemental funding provided by the Lance Armstrong Foundation.

  2. EPEC - Oncology Education in Palliative and End-of-life Care - Oncology Module 7 Communicating Effectively

  3. Overall message A structured approach to communicating helps the oncologist perform this important role

  4. Objectives • Demonstrate ability to apply a 6-step protocol for delivering information • Know what to do at each step

  5. Video

  6. Importance • Most people want to know • Strengthens physician-patient relationship • Fosters collaboration • Permits patients, families to plan, cope

  7. 6-step protocol . . . 1. Getting started 2. Find out what the patient knows 3. Find out how much the patient wants to know Adapted from Robert Buckman

  8. . . 6-step protocol 4. Share the information 5. Respond to patient, family feelings 6. Plan, follow-up Adapted from Robert Buckman

  9. Step 1: Getting started . . . • Plan what you will say • Confirm medical facts • Don’t delegate • Create a conducive environment

  10. . . . Getting started • Allot adequate time • Prevent interruptions • Determine who else the patient would like present • If child, patient’s parents

  11. Step 2: What does the patient know? • Establish what the patient knows • Child’s parents • Assess ability to comprehend new bad news • Reschedule if unprepared

  12. Step 3: How much does the patient want to know . . . • Recognize, support various patient preferences • Decline voluntarily to receive information • Designate someone to communicate on his or her behalf

  13. . . . Step 3: How much does the patient want to know • People handle information differently • Race, ethnicity, culture, religion, socioeconomic status • Age and developmental level

  14. Advance preparation • Initial assessment • Preparation for critical tests • What does the patient know? (step 2) • How does the patient handle information? (step 3)

  15. When family says‘don’t tell’ . . . • Legal obligation to obtain informed consent from the patient • Promote congenial family alliance • Honesty with a child promotes trust

  16. . . . When family says‘don’t tell’ • Ask the family: • Why not tell? • What are you afraid I will say? • What are your previous experiences? • Is there a personal, cultural, or religious context? • Talk to the patient together

  17. Step 4: Share the information . . . • Say it, then stop • Avoid monologue, promote dialogue • Avoid jargon, euphemisms • Pause frequently • Check for understanding • Use silence, body language

  18. . . . Step 4: Share the information • Don’t minimize severity • Avoid vagueness, confusion • Implications of “I’m sorry”

  19. Step 5: Respond to feelings . . . Normal reactions • Affective response • Tears, anger, sadness, love, anxiety, relief, other • Cognitive response • Denial, blame, guilt, disbelief, fear, loss, shame, intellectualization • Basic psychophysiologic response • Fight-flight

  20. . . . Step 5: Respond to feelings . . . • Be prepared for • Outburst of strong emotion • Broad range of reactions • Give time to react

  21. . . . Step 5: Respond to feelings • Listen quietly, attentively • Encourage descriptions of feelings • Use non-verbal communication

  22. Step 6: Planning, follow-up . . . • Plan for the next steps • Additional information, tests • Treat symptoms, referrals as needed • Discuss potential sources of support

  23. . . . Step 6: Planning, follow-up • Give contact information, set next appointment • Before leaving, assess: • Safety of the patient • Supports at home • Repeat news at future visits

  24. When language is a barrier . . . • Use a skilled translator • Familiar with medical terminology • Comfortable translating bad news • consider telephone translation services

  25. . . . When language is a barrier • Avoid family as primary translators • Confuses family members • How to translate medical concepts • Modify news to protect patient • Supplement the translation • Speak directly to the patient

  26. Summary A structured approach to communicating helps the oncologist perform this important role

More Related