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    Breaking Bad News 18 Juni 22 Venita

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    Ridho Putra
    The document discusses best practices for delivering bad news to patients and their families in the medical field. It begins by emphasizing the importance of communication skills when sharing a cancer diagnosis, terminal illness prognosis, or treatment outcomes. The challenges staff face include dealing with denial, transferring emotions, and lack of experience. Effective communication can help minimize emotional and psychological impacts. The document then provides guidance on preparing the setting, assessing the patient's perspective, inviting them to learn their condition, delivering knowledge empathetically, and summarizing next steps. Overall it stresses the value of honesty, empathy, and focusing on the patient as a person when sharing difficult information.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Breaking Bad News 18 Juni 22 Venita

    Uploaded by

    Ridho Putra
    35 views32 pages
    The document discusses best practices for delivering bad news to patients and their families in the medical field. It begins by emphasizing the importance of communication skills when sharing a cancer diagnosis, terminal illness prognosis, or treatment outcomes. The challenges staff face include dealing with denial, transferring emotions, and lack of experience. Effective communication can help minimize emotional and psychological impacts. The document then provides guidance on preparing the setting, assessing the patient's perspective, inviting them to learn their condition, delivering knowledge empathetically, and summarizing next steps. Overall it stresses the value of honesty, empathy, and focusing on the patient as a person when sharing difficult information.

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    The document discusses best practices for delivering bad news to patients and their families in the medical field. It begins by emphasizing the importance of communication skills when sharing a cancer diagnosis, terminal illness prognosis, or treatment outcomes. The challenges staff face include dealing with denial, transferring emotions, and lack of experience. Effective communication can help minimize emotional and psychological impacts. The document then provides guidance on preparing the setting, assessing the patient's perspective, inviting them to learn their condition, delivering knowledge empathetically, and summarizing next steps. Overall it stresses the value of honesty, empathy, and focusing on the patient as a person when sharing difficult information.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    35 views32 pages

    Breaking Bad News 18 Juni 22 Venita

    Uploaded by

    Ridho Putra
    The document discusses best practices for delivering bad news to patients and their families in the medical field. It begins by emphasizing the importance of communication skills when sharing a cancer diagnosis, terminal illness prognosis, or treatment outcomes. The challenges staff face include dealing with denial, transferring emotions, and lack of experience. Effective communication can help minimize emotional and psychological impacts. The document then provides guidance on preparing the setting, assessing the patient's perspective, inviting them to learn their condition, delivering knowledge empathetically, and summarizing next steps. Overall it stresses the value of honesty, empathy, and focusing on the patient as a person when sharing difficult information.

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    © All Rights Reserved
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    You are on page 1of 32

    Breaking

    Bad News

    Dr Venita Eng, MSc, CT


    Berita Buruk?

    “Pak/Bu, Dokter ingin


    bicara…”
    The Art of Breaking Bad News

    "If we do it badly, the patients or family members


    may never forgive us;
    if we do it well,
    they may never forget us" (Buckman, 1992)
    Menyampaikan
    Berita Buruk

    Sebuah keharusan yang pelik


    Berita Pahit di Dunia Medis

    Diagnosis
    Kanker, penyakit terminal

    Respon Terapi
    Progresivitas penyakit, respon
    minimal terhadap pengobatan

    Prognosis dan Kondisi


    Prognosis ad malam, kondisi
    akhir kehidupan
    Mengapa Keterampilan Menyampaikan Berita
    Sangat Penting?

    Dampak Dampak
    Dampak Relasi
    Emosional Kepercayaan ke tim, Kesehatan
    Reaksi sedih, marah, Ambang nyeri,
    kelanjutan terapi, konflik
    menyangkal, frustasi psikosomatis
    intra dan interpersonal
    pasien dan keluarga,
    Yin HS. Breaking Bad News. In : Koh M, Hum A (ed). The Bedside
    Communication Handbook. World Scientific Publishing. 2021.
    tuntutan
    Eng V, Hewitt V, Kekalih A. 2020. Preference for Initiation of End-of-Life Care Discussion: a quantitative study
    Kekuatiran Staf dan Tantangan dalam
    Menyampaikan Berita

    Penolakan Transfer Emosi


    termasuk penyangkalan
    Dimarahi, ikut sedih,
    pasien/keluarga atau
    menangis
    disalahkan

    Kurang Waktu
    Pengetahuan / Membutuhkan waktu
    Pengalaman yang panjang

    Eng V, Hutabarat WR. 2021. Perception and Experience of Clinical Staff in Cancer Center about End-of-Life
    Care. Poster presentation, Asia Pacific Hospice Conference 2021.
    Lebih dari Sekadar Kata
    dr Venita Eng, MSc. [email protected]
    ISICEM18: Breaking bad news in the ICU

    dr Venita Eng, MSc. [email protected]


    dr Venita Eng, MSc. [email protected]

    VALUE

    ● Value family statements


    ● Acknowledge family emotions
    ● Listen to the family
    ● Understand the patient as a person
    ● Elicit family questions

    ISICEM18: Breaking bad news in the ICU


    Microskills
    OARS

    ● ask Open questions

    ● make Affirming statement

    ● practice Reflective listening

    ● Summarizing
    Miller, W. Motivational Interviewing. The Guilford Press, 2002 New York.
    that…” obvious

    Three fundamental skills

    Example N otes
    Tell me more “ Tell me more about…” Use when you are not sure what
    someone is talking about (rather
    than jump to an assumption).

    Ask-tell-ask “ What do you think about…” Related to Assess-Knowledge-


    “ Here’s what the tests show” Respond in SPIKES. Think of this
    “ Does that make sense…?” as one unit of information transfer

    “ I wish” “ I wish I could say that the Enables you to align with the
    statements chemo always works” patient while acknowledging the
    reality of the situation
    !
    Hashim M. J. (2017). Patient-
    Centered Communication: Basic
    Skills. American family
    physician, 95(1), 29–34.
    Hashim M. J. (2017). Patient-Centered
    Communication: Basic Skills. American
    family physician, 95(1), 29–34.
    dr Venita Eng, MSc. [email protected]

    SELALU SIAPKAN BERITA BAIK


    dr Venita Eng, MSc. [email protected]

    Good news ?

    ● Bebas nyeri
    ● tidak merasakan penderitaan
    ● Dalam pengawasan intensif
    ● Pasien tidak sendirian
    ● Keluarga diberikan kesempatan untuk bertemu dan berdoa
    ● Pasien dan keluarga punya pilihan
    Studi
    Kasus
    Berita Buruk di Hari Libur

    Ny L, 57 tahun asal Bogor, sedang berlibur bersama keluarga ke Jogja dan mendadak
    mengeluh sesak nafas yang semakin memberat. Sebelumnya tidak ada riwayat sakit
    berat pada pasien, dan keluarga menyangka pasien terkena COVID-19. Pasien segera
    dibawa ke UGD dan dilakukan pemeriksaan penunjang. Setelah dilakukan CT Scan,
    ditemukan massa multipel di kedua paru sugestif maligna dan adanya lesi metastasis
    di hepar. Anda sebagai Dokter penanggung jawab pasien saat ini bertugas
    menyampaikan hasil diagnosa ke pasien serta rencana pemeriksaan dan terapi
    selanjutnya
    Setting
    ● Persiapan poin yang perlu disampaikan
    ● Print out hasil atau menyiapkan layar
    ● Persiapan mental
    ● Pastikan privasi
    ● Libatkan keluarga
    ● Persiapan ruangan : tempat duduk, meja, tisu
    ● Bangun rapport
    ● Hindari interupsi
    ● Perkenalan tim dan keluarga

    Yin HS. Breaking Bad News. In : Koh M, Hum A (ed). The Bedside
    Communication Handbook. World Scientific Publishing. 2021.
    Perception

    ● Mulai dengan pertanyaan terbuka,


    gali persepsi pasien dan keluarga
    ● Kaji pengetahuan pasien dan
    keluarga
    ● Reafirmasi

    Yin HS. Breaking Bad News. In : Koh M, Hum A (ed). The Bedside
    Communication Handbook. World Scientific Publishing. 2021.
    Invitation
    ● Kaji keinginan pasien untuk
    mengetahui kondisinya, sejauh mana
    ● Cari tahu alasan jika ada penolakan
    ● Hargai keinginan pasien
    ● Hindari asumsi
    ● Berikan “warning shot”
    ● Ingat “ask-tell-ask”
    ● Berikan “second warning shot”

    Yin HS. Breaking Bad News. In : Koh M, Hum A (ed). The Bedside
    Communication Handbook. World Scientific Publishing. 2021.
    Knowledge

    ● Hindari jargon dan istilah teknis tanpa


    penjelasan
    ● Sesuaikan informasi dengan tingkat
    pendidikan
    ● “bite size information”
    ● Sensitif terhadap respon non-verbal
    ● Pertahankan harapan
    ● Refleksi isi dan perasaan

    Yin HS. Breaking Bad News. In : Koh M, Hum A (ed). The Bedside
    Communication Handbook. World Scientific Publishing. 2021.
    Empathy
    ● Observasi emosi pasien dan keluarga, berikan respon
    sesuai
    ● Ijinkan pasien untuk mengeluarkan emosi, bicara,
    menangis, atau diam
    ● Usahakan tetap nyaman walau diam, berikan jeda
    ● Jika pasien lama terdiam, berikan pertanyaan terbuka
    ● Jika sesuai, dapat mendekat atau memberikan sentuhan
    ke pasien
    ● Validasi perasaan dan pemikiran pasien
    ● Menjawab kekuatiran pasien

    Yin HS. Breaking Bad News. In : Koh M, Hum A (ed). The Bedside
    Communication Handbook. World Scientific Publishing. 2021.
    Strategy and Summary

    ● Rangkum isi pembicaraan


    ● Rencana tindak lanjut yang jelas dapat mengurangi kekuatiran /
    kegelisahan pasien
    ● Koreksi lembut jika ada mispersepsi atau ketidaksesuaian ekspektasi
    ● Menerima jika pasien belum siap menerima rencana tindak lanjut
    ● Jika keluarga tidak terlibat, tawarkan keterlibatan keluarga di pertemuan
    selanjutnya
    ● Debriefing bagi pemberi informasi

    Yin HS. Breaking Bad News. In : Koh M, Hum A (ed). The Bedside
    Communication Handbook. World Scientific Publishing. 2021.
    Tips praktis

    ● Antisipasi dan persiapan : status dan Riwayat pasien,


    diskusi multidisiplin, antisipasi pertanyaan
    ● Jujur, dan hindari eufemisme
    ● Menerima dengan lembut jika ada penolakan
    ● Tulus

    Yin HS. Breaking Bad News. In : Koh M, Hum A (ed). The Bedside
    Communication Handbook. World Scientific Publishing. 2021.
    Kesimpulan

    ● Tenaga medis perlu memiliki


    ketrampilan menyampaikan berita
    buruk
    ● Penyampaian tidak mudah, namun
    terdapat pedoman yang sistematis
    – SPIKES , VALUE, OARS
    ● Ketulusan dan Hati yang mengasihi
    adalah unsur terpenting
    Terima Kasih
    [email protected]

    CREDITS: This presentation template was created by Slidesgo,


    including icons by Flaticon, and infographics & images by Freepik.
    Please keep this slide for attribution.

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