Breaking Bad (News)

Summary by David Anderson

What is the problem?

Delivering bad news and having an end of life conversation are core skills for any practitioner who deals with critically ill patients. Current data show that while 22% of deaths in the USA now occur in ICU, 54% of families surveyed have a poor understanding of patient’s diagnosis, treatment plan and prognosis. Dr. Kate Granger found this out first hand while admitted to hospital in the UK and started the #hellomynameis campaign.

What is the evidence?

While families feel more validated if given longer to speak, doctors speak for 71% of the time in family meetings.
Longer meetings are also associated with greater patient and family member satisfaction.
Patients perceive that doctors spend longer with them if the doctor is sitting down.
Use of a simple mnemonic increases satisfaction and reduced the incidence of PTSD in family members.

What do experts do?

Prepare for the meeting. Decide who will attend, what you will talk about and what your goals are.
Introduce everyone and explain the agenda.
Gather everyone’s understanding
Listen and don’t interrupt
Empathise (physicians express no empathy in 1/3 of family meetings)
Make the patient’s voice heard
Make your recommendation to go forward
Reflect on the meeting after it concludes

What about the difficult situations?

Hope is an issue that comes up often. Many other specialties emphasise the importance of hope, while intensivists are often seen as being nihilistic. But we can still foster a degree of hope in patients and families without being unrealistic.

Techniques for managing conflict are discussed such as identifying discord in the family and avoiding mixed messages from staff.

The importance of spirituality is discussed.