Delivering difficult news in a remote setting presents unique challenges. Effective communication must adapt to the absence of physical presence, emphasising empathy and sensitivity.
This guide outlines enhanced strategies for GP trainees preparing for the MRCGP SCA, focusing on the SPIKES protocol and ABCDE method. You will also learn from a mock SCA case demonstration.
SPIKES Protocol
The SPIKES protocol provides a structured approach for delivering bad news with clarity and compassion:
Setting: Ensure a private, comfortable environment with minimal interruptions. Confirm the patient is in a suitable place and it’s a good time to talk.
Perception: Before sharing news, understand the patient’s perspective and awareness of their condition. Ask, “What have you understood about your condition so far?” Listen more than you speak to gauge their insight.
Invitation: Respect patient autonomy by asking if they’re ready for the information and how much detail they prefer.
Knowledge: Communicate clearly, using simple, non-technical language. Break the news in manageable segments, allowing time for absorption and understanding.
Emotions: Recognize and address the patient’s emotional responses. Express empathy and support, encouraging them to share any immediate feelings or concerns.
Strategy and Summary: Collaborate on a forward plan. Summarize the key points discussed to confirm understanding and clarify next steps.
ABCDE Method
The ABCDE method supports the above protocol with additional focus:
- Advance Preparation: Gather all relevant information. Anticipate and prepare for potential reactions. Emotionally ready yourself for delivering the news.
- Build a Therapeutic Relationship: Establish trust through empathy, active listening, and respecting the patient and their family’s viewpoints.
- Communicate Well: Use straightforward language and pause frequently for questions. Encourage the patient to express any concerns or misunderstandings.
- Deal with Patient and Family Reactions: Prepare for varied emotional reactions. Offer empathy, validation, and support. Provide resources for additional help if needed.
- Encourage Emotions and Empathic Responses: Create a safe space for the patient and their family to process and express their feelings, facilitating a supportive healing environment.
Mock SCA Practice
The approach to delivering bad news differs significantly from routine history-taking. One common error in SCA is extending the initial history-taking phase, thereby postponing the disclosure of test results beyond the advisable timeframe.
To avoid unnecessary patient anxiety and the subsequent rush in clinical management, share the results around three minutes or earlier if possible.
4 Actionable SCA Practice Tips
Give a Warning Shot
Begin with a gentle preface to prepare the patient, known as a “warning shot”:
“I’m afraid it’s not the news we hoped for.”
This statement sets the tone for the seriousness of the information that follows.
Communicate the Diagnosis Clearly
Proceed with delivering the results, ensuring your language is clear and direct to avoid any ambiguity. For example:
“The scan has revealed cancer in your bowel.”
Allow Time for Absorption
After sharing such significant news, it’s crucial to provide the patient with a moment to process the information. This pause not only respects their emotional response but also prepares them for further discussion about their health.
Address Patient’s Emerging Concerns
Once the initial news has been absorbed, it’s essential to explore the patient’s concerns and questions. Treat this phase as a fresh start to the consultation, focusing on the patient’s needs and emotions as they adjust to the news.
By using proven methods, you can ensure that the delivery of difficult news is handled with clarity and sensitivity, facilitating a supportive patient-doctor relationship during these challenging conversations.
How Dr Lawrence passed SCA?
After a failed SCA attempt with a score of 69, Dr Lawrence’s confidence was crushed. Check out how Dr Lawrence conquered SCA after this major setback.
