urgent

[sherry17]

can someone give me a few tips about the questionarre to be asked to a SP when one has to deliver a bad news like cancer or HIV positive status

[maixungphong]

Originally Posted by sherry17

can someone give me a few tips about the questionarre to be asked to a SP when one has to deliver a bad news like cancer or HIV positive status

A six-step framework for communicating bad news can be used as a guide for these difficult conversations.
Step 1: Preparation

Discussions of bad news require careful preparation. Before delivering bad news to a patient, plan what will be discussed, ensure the medical facts, and ensure that all needed confirmation is available. Establishing the proper physical context is also important. Ideally, bad news should be delivered in person in a private area in which there will be no interruptions. Allot adequate time for discussions, minimize interruptions, and determine whether any support staff, family, or friends that the patient may want on hand are available.
Step 2: Establishing the Patient’s Understanding

Begin the discussion by exploring the patient’s knowledge of the illness. Patients with a thorough understanding of their illness require a different approach than an uninformed or less sophisticated patient. Useful questions to elicit this information include the following: “What do you understand about your illness?” “When you first had symptom x, what did you think it might be?” “What have other doctors told you about your condition or procedures that you have had?”
Step 3: What the Patient Wants to Know

Although the majority of Americans say they want to be fully informed about their illnesses, a substantial minority may not want to know the full details or may prefer to have another family member informed. Data suggests that this may be particularly true for certain ethnic groups. (See also Cultural Aspects of Care.) Just as patients have the right to be told the truth, they also have the right to decline to learn unwanted information. Thus, it is crucial to establish how much each patient wants to know. Helpful questions to ask include the following: “If this condition turns out to be something serious, do you want to know?” “Would you like me to tell you the full details of your condition? If not, is there somebody else you would like me to talk to?”
Step 4: Telling the Patient

Once the physician has established the patient’s understanding of the illness and willingness to hear bad news, it is time to tell the patient. Deliver information in a sensitive, straightforward manner, avoiding technical language or euphemisms. Frequently check for understanding and clarify difficult concepts and terms. Phrasing that includes a “warning shot” helps brace and prepare patients for the bad news. For example: “Mr. X, I feel bad to have to tell you this, but the growth turned out to be cancer.” “The report is back, and it’s not as we had hoped. It showed that there is cancer in your colon.”
Step 5: Responding to Feelings

The responses of patients and families are both unpredictable and diverse. Active listening, encouraging the expression of emotion, and acknowledging patient’s emotions are all important and helpful. Useful probes to help elicit an understanding of the patient’s emotions include the following: “What does this news mean to you?” “What worries you the most?” “You appear angry. Can you tell me what you are feeling?” “Tell me more about how you are feeling about what I just said.”
Step 6: Planning and Follow-Up

Finally, the physician should organize an immediate therapeutic plan that includes specific references to the patient’s concerns and incorporates the patient’s agenda. The plan should include an appointment for a follow-up visit; a discussion of additional tests, referrals, and sources of support; and information as to how you can be reached if additional questions arise. The physician also needs to ensure that the patient will be safe when he or she leaves the office.