Breaking Bad News Dr. Robert Buckman (drbuckman.com) Bad news is information that seriously and adversely affects the patient's view of his or her future.
Acknowledge emotion in the room

Breaking Bad News: S = setting (get the setting right) P = perceives (what the person perceives) I = invitation (an invitation to share the news) K = knowledge (Giving the knowledge) E = empathize and explore (and exploring the patient's emotions) S = strategies and summarize

Breaking Bad News: S = setting (get the setting right) P = perceives (what the person perceives) I = invitation (an invitation to share the news) K = knowledge (Giving the knowledge) E = empathize and explore (and exploring the patient's emotions) S = strategies and summarize When need to give information: C = context (if on telephone "set agenda".) O = opening shot (talk slowly let grasp situation) N = narrative (talk slowly, describe events in chronological order) E = emotion S = strategy and summarize

If asked: Stop and go to "end" and give expression of regret.

Note: If asking if dead: Anything other than no is a yes.

Developing Compassion

Gerry Goldberg Ph.D., C. Psych.

1 Relentless Self-criticism

Traumatic events lead to self-doubt about actions resulting in guilt, shame, etc.—particularly when it comes to first responders!

Guilt, shame, etc. can lead to burnout.

Burnout is a form a depression in which there is a decreased ability to show compassion.

Developing compassion towards others and one’s self, as part of a resilient lifestyle, may protect against burnout.

What is compassion? Compassion is not religious business, is human business; it is not luxury, it is essential for our own peace and mental stability; it is essential for human survival. The Dalai Lama

Definition:

Buddhist A loving kindness; open heartedness ‘deep feeling and understanding of the suffering of others associated with a deep commitment and responsibility to try to alleviate it’

Gilbert (1989, 2000, 2005) A mental orientation that combines care focused qualities of mind and is dependent on those qualities.

Creates an opportunity for growth and change with warmth

Compassion and self-compassion may be viewed as a set of processes that can be developed. In what ways might we develop each of the following processes so that we can be better at offering compassion to others and ourselves? Self-compassion is central to looking after one’s self and is important in preventing burnout. Without self-compassion we are not likely to be effective in providing compassion to others. Gilbert, Lee and Welford (2006) suggest there are seven processes that underpin compassion: Care for well-being includes the capacity to be motivated to care for others and to promote their well-being. Distress and need sensitivity includes the capacity to be sensitive to the nature and complexity of distress. This requires the ability to read emotions and cues and to have an awareness of distress. It involves the emotional ability to be sensitive to people needs and requirements that will help them prosper. Sympathy is the ability to be emotionally moved by the distresses and the joys of others. Distress tolerance is the ability not to be overwhelmed by the distress of others and not to lose y our ability to truly help. Empathy involves different qualities such as emotional resonance (feeling the same as others or being in tune with others). It also involves cognitive awareness about the reasons for behaviour, intentions and motivations. Non-judgment is the ability to engage in the complexities of people’s emotions and lives without judging. Warmth is an emotional quality of gentleness and kindness that operates through all of the above. Based upon “The Compassionate Mind” (Gilbert, Lee and Welford, 2006)

2 On the sheets provided, list what adds to or drains each of these capacities.

Care for well-being Distress/Need Sensitivity Sympathy Distress Tolerance What adds to this capacity? What adds to this capacity? What adds to this capacity? What adds to this capacity? •practice religious faith •practice active listening •when appropriate, let down •take a breath •focus on humanism •practice asking questions in a non- emotional defences •use controlled breathing techniques •cultural/ethnic values judgemental manner •accept the emotions (pain and joy) •take time out to gather self •recall family values •read body language •accept that pain and joy are part of •deal with your personal issues (clear •remember a role model •listen for “hazy” answers the fabric of life your plate) •clear self of pre-existing expectations •at times, create emotional distance by (clear mindset) recalling your role and/or reminding self it is their issue not yours (i.e. don’t take ownership of what is not yours) •keep sense of humour

What drains this capacity? What drains this capacity? What drains this capacity? What drains this capacity?

Empathy Non-judgment Warmth What adds to this capacity? What adds to this capacity? What adds to this capacity? •reflect on own issues and how they •ask open ended non-judgemental •focus on the moment were resolved questions. •give freely of your time •use self as a benchmark •always treat all people with common •look at the person •see beyond the negative qualities and courtesy •give the benefit of doubt try to see the whole person • reflect that judgements can come back on self??? • focus on the situation and person not on the history of the individual

What drains this capacity? What drains this capacity? What drains this capacity?

TOOLS FOR HELPING PARAMEDICS SHOW COMPASSION

Why are Tools for Showing Compassion Necessary?

3 Tools for Showing Paramedics Care

“I Can’t Stop Crying” (John D. Martin, 1992).

“Trauma, Loss and Bereavement” (MADD)

Teddy bear program

Tools to show compassion

List of ideas for dealing with family and friends, and specifically, how to tell them that a loved one has died. (This information was developed for the most part from a survey of the staff’s own ideas, in a “skills exchange” process. )

4 Tools to show compassion

• Each unit also carries pamphlets from the organization Bereaved Families of Ontario, which helps family members to deal with the loss of a child. Names and telephone

• numbers of agencies that provide additional supports for patients, their families and the public.

Tools to show compassion

Working with organizations to give those stranded by misfortune discounts on accommodation, food, clothing, transportation, maps and telephone calls.
Community involvement.
Trust funds for patients who were in dire need of emergency funds.
Identify older people who live alone to invite them for assessment of their health and situation.
public awareness programs
Time to help grieving families

Offering support to patients with cancer, what paramedics can do. Prepared by Dr. Gerry Goldberg, Psychologist

Let them know that the disease does not make you see them as a social outcast. Paramedics commonly transport people with cancer to and from treatments, as well as to hospital for emergencies. Often these situations provide only brief time to do anything more than perform medical/technical procedures. Nevertheless, paramedics can improve their quality of service by becoming sensitive to the social-emotional supports they can provide to cancer patients. Listen to the person with cancer . Listening is key to giving support. A paramedic can show someone is there to listen to expression of feelings and perhaps act as a sounding board for a discussion of future plans. Paramedics do not necessarily need to "do" anything. "I'm here" being the most supportive words you can say. In dealing with cancer patients several points should be kept in mind:
each cancer patient will cope in an individual way
many are far from family ties and/or unable to confide in them
most have feelings of anguish and loneliness that they believe "no one else can share"
not everyone does listen, many shut out what the person with cancer is saying. Direct the person with cancer to support groups . Persons with cancer may need to find new meaning to their days and ways of using each day to its fullest. Expressing and sharing these needs and other feelings and fears are important for the person. Often all they need is silent support, a respite, or shelter, or island of normality; a safe harbor and not necessarily another person to solve their problems. You can direct the patient to a toll-free telephone number 1-888-939-3333 (open Monday to Friday 9 a.m. to 6 p.m.) that the Canadian Cancer Society has made available to support cancer patients as well as provide them information about the disease and treatments.

5 Say enough to show you are willing to be a companion at least while you are with them. There is a risk of saying the wrong thing . Therefore, listening is best. However, there is little comfort knowing that "out there" are people with so little confidence in their worth as companions that they would rather say nothing than risk saying the wrong thing. Be natural, be yourself . Don't try to be someone you are not. Allow intuition guide you. Let the person with cancer call the shots. Let them decide if they are ready to talk . While there may be a desire to try to help persons through fears and other issues, allowing the person to decide when they are ready to talk is important. However, you can look for signals to detect if it is a good time to talk. For example if the person seems unusually nervous or initiates apparently idle conversation, these may be a sign the person does not know how to begin.

Be prepared for common fears of persons with cancer . A diagnosis of cancer can bring on many fears.

Two researchers, Pollin and Golant (1994), described many of these fears, including the following.
The fear of loss of control or helplessness.
The fear of loss of self-image: feeling less attractive, physically weaker or somehow damaged.
The fear of dependency. This may cause difficulty asking for outside help.
The fear of a stigma and feelings of shame.
The fear of abandonment. (a primitive fear).
The fear of expressing anger. People are often taught that anger is an unwelcome emotion.
The fear of isolation: physical, social and emotional isolation.
The fear of death. The fear of one's own mortality.

Be prepared for anger . Paramedics may find themselves or the system or the person's family the target of much anger and frustration. You may need to remind yourself that you are not the cause of their anger and respond with patience and compassion. Remember anger could be a reaction to fear.

Avoid false cheer as a response to anger . Phrases like "everything will be all right". They may view this as a denial of the reality of their world, especially their feelings and fears.

Help focus anger or anxiety by exploring specific causes : eg. drug reactions, job, situation, finances, etc.

Remind patients that some cancer treatments commonly cause sick feelings and are not necessarily a sign that cancer is returning . Cancer treatments can take both a physical and emotional toll on people with cancer. It can be difficult to appreciate that one is recovering when one feels rotten. This is especially true of people who have to return to the hospital repeatedly.

6 Use statistics carefully . Citing statistics regarding cancer can be of value to the patients, but avoid denying the individuality of the case with these numbers. No two cancers are the same. Help the person with cancer ask questions . Many people do not like to ask important questions as they fear being thought of as ignorant or pushy. Support them in asking questions. Direct your questions to the patient . Well- meaning family and friends may start answering questions for the patient. At times this may be necessary, but do your best to listen to the patient first. Show them you see the person "not just the disease" .

7