discussing poor prognosis

Procedure

• prepare for the meeting
  • have all medical facts available
  • prepare & appropriate environment
• establish patient's understanding
  • "What do you understand about your illness?"
  • "What have the doctors told you about your illness?
• determine how much the patient wants to know
  • regardless of presence of others or prior expressed opinions of others
  • "Would you like me to tell you the full details of your condition? If not, is there someone else you would like me to talk to?"
• tell patient if he/she wants to know
  • deliver information in a sensitive straightforward manner
  • avoid technical language or euphemisms
  • check for understanding
  • phrasing that includes a warning helps prepare patients for bad news
    • example: Your report is back, but it's not what we had hoped for. It says you have lung cancer.
• acknowledge the patient's emotional response
• explore patient's values & motivations
  • if patient asks "Is this the end?", respond "tell me more about what you mean"
• establish a plan that includes
  • follow-up visit
  • contact information should additional questions arise
• also see SPIKES protocol for breaking bad news
• anxiety, depression, PTSD, satisfaction similar if bad news delivered in person or by phone

* see disclosure for family concerns regarding discussing poor prognosis

Notes

• if language is a barrier, use a professional medical interpreter
• Congress has directed the Department of Health & Human Services to have test results as soon as they are available
  • thus patients may receive test results before a physician has a chance to explain the test results

More general terms

• patient education; patient-clinician communication

Additional terms

• disclosure
• Setting Perception Invitation Knowledge Empathy Strategies (SPIKES) protocol for breaking bad news