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A Person-Centered Approach to Breaking Bad News

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Neurologic and Neurodegenerative Diseases of the Larynx

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Abstract

Receiving a neurological diagnosis is typically an extraordinarily difficult time for patients and their families and has been described as a type of existential shock. Communicating the news of a serious diagnosis is a frequent yet stressful part of the work of many health professionals. In this chapter, an evidence-based resource on how to discuss difficult neurological diagnoses with patients and their families is provided. The SPIKES protocol for communicating bad news is described. Its applicability to communicating the diagnosis on motor neuron disease is then explored, with data from neurologists, patients, and their family members. A case study and real-life examples are used to illustrate the components and the complexities of best-practice communication of a neurological diagnosis. The delivery of bad news, such as communicating a serious diagnosis, is not an optional part of clinical practice; instead, it is imperative that health professionals are prepared to deliver bad news. Communicating the diagnosis in an evidence-based and person-centered manner is necessary in order to promote optimal outcomes for patients and their families; doing so also has the added benefit of mitigating against the stress experienced by health professionals when delivering bad news.

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References

  1. Pakpoor J, Goldacre M. Neuroepidemiology: the increasing burden of mortality from neurological diseases. Nat Rev Neurol. 2017;13(9):518–9.

    Article  Google Scholar 

  2. Mitchell JD, Borasio GD. Amyotrophic lateral sclerosis. Lancet. 2007;369(9578):2031–41.

    Article  CAS  Google Scholar 

  3. Kiernan MC, Vucic S, Cheah BC, Turner MR, Eisen A, Hardiman O, et al. Amyotrophic lateral sclerosis. Lancet. 2011;377(9769):942–55.

    Article  CAS  Google Scholar 

  4. Seeber AA, Pols AJ, Hijdra A, Grupstra HF, Willems DL, de Visser M. Experiences and reflections of patients with motor neuron disease on breaking the news in a two tiered appointment: a qualitative study. BMJ Support Palliat Care. 2016;0:e1–9.

    Google Scholar 

  5. O’Brien MR, Whitehead B, Jack BA, Mitchell JD. From symptom onset to a diagnosis of amyotrophic lateral sclerosis/motor neuron disease (ALS/MND): experiences of people with ALS/MND and family carers—a qualitative study. Amyotroph Lateral Scler. 2011;12(2):97–104.

    Article  Google Scholar 

  6. Baile WF, Lenzi R, Parker PA, Buckman R, Cohen L. Oncologists' attitudes toward and practices in giving bad news: an exploratory study. J Clin Oncol. 2002;20(8):2189–96.

    Article  Google Scholar 

  7. Ptacek JT, Ptacek JJ, Ellison NM. “I′m sorry to tell you…” Physicians' reports of breaking bad news. J Behav Med. 2001;24(2):205–17.

    Article  CAS  Google Scholar 

  8. Orlander JD, Fincke G, Hermanns D, Johnson GA. Medical residents’ first clearly remembered experiences of giving bad news. J Gen Intern Med. 2002;17(11):825–40.

    Article  Google Scholar 

  9. Alelwani SM, Ahmed YA. Medical training for communication of bad news: a literature review. J Edu Health Promot. 2014;3:51.

    Google Scholar 

  10. Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer. Oncologist. 2000;5(4):302–11.

    Article  CAS  Google Scholar 

  11. Studer RK, Danuser B, Gomez P. Physicians’ psychophysiological stress reaction in medical communication of bad news: a critical literature review. Int J Psychophysiol. 2017;120:14–22.

    Article  Google Scholar 

  12. Fujimori M, Shirai Y, Asai M, Kubota K, Katsumata N, Uchitomi Y. Effect of communication skills training program for oncologists based on patient preferences for communication when receiving bad news: a randomized controlled trial. J Clin Oncol. 2014;32(20):2166–72.

    Article  Google Scholar 

  13. Dias L, Chabner BA, Lynch TJ Jr, Penson RT. Breaking bad news: a patient’s perspective. Oncologist. 2003;8(6):587–96.

    Article  Google Scholar 

  14. Berterö C, Vanhanen M, Appelin G. Receiving a diagnosis of inoperable lung cancer: patients’ perspectives of how it affects their life situation and quality of life. Acta Oncol. 2008;47(5):862–9.

    Article  Google Scholar 

  15. Aoun S, Connors S, Priddis L, Breen LJ, Colyer S. Motor neurone disease family carers’ experiences of caring, palliative care, and bereavement: an exploratory qualitative study. Palliat Med. 2012;26(6):842–50.

    Article  Google Scholar 

  16. Solari A. Effective communication at the point of multiple sclerosis diagnosis. Mult Scler. 2014;20:387–402.

    Google Scholar 

  17. McCluskey L, Casarett D, Siderowf A. Breaking the news: a survey of ALS patients and their caregivers. Amyotroph Lateral Scler. 2004;5:131–5.

    Google Scholar 

  18. Aoun SM, Breen LJ, Oliver D, Henderson R, O’Connor M, Edis RM, et al. Family carers' experiences of receiving the news of a diagnosis of motor neurone disease: a national survey. J Neurol Sci. 2017;372:144–51.

    Article  Google Scholar 

  19. Aoun SM, Breen LJ, Howting D, Edis R, Oliver D, Henderson R, et al. Receiving the news of a diagnosis of motor neuron disease: what does it take to make it better? Amyotroph Lateral Scler Frontotemporal Degener. 2016;17(3–4):168–78.

    Article  Google Scholar 

  20. EFNS Task Force on Diagnosis and Management of Amyotrophic Lateral Sclerosis, Andersen PM, Abrahams S, Borasio GD, de Carvalho M, Chio A, Van Damme P, et al. EFNS guidelines on the clinical management of amyotrophic lateral sclerosis (MALS)-revised report of an EFNS task force. Eur J Neurol. 2012;19(3):360–75.

    Article  Google Scholar 

  21. Aoun SM, Breen LJ, Edis R, Henderson R, Oliver D, Harris R, et al. Breaking the news of a diagnosis of motor neurone disease: a national survey of neurologists’ perspectives. J Neurol Sci. 2016;367:368–74.

    Article  Google Scholar 

  22. Aoun SM, O’Brien MR, Breen LJ, O’Connor M. ‘The shock of diagnosis’: qualitative accounts from people with motor neurone disease reflecting the need for more person-centred care. J Neurol Sci. 2018;387:80–4.

    Article  Google Scholar 

  23. O’Connor M, Aoun S, Breen LJ. Australian family carer responses when a loved one receives a diagnosis of motor neurone disease—“our life has changed forever”. Health Soc Care Comm. 2018;26:2415–21.

    Google Scholar 

  24. Brown JB. User, carer and professional experiences of care in motor neurone disease. Primary Health Care Research and Development. 2003;4:207–17.

    Article  Google Scholar 

  25. Schellenberg KL, Schofield SJ, Fang S, Johnston WS. Breaking bad news in amyotrophic lateral sclerosis: the need for medical education. Amyotroph Lateral Scler Frontotemporal Degener. 2014;15(1–2):47–54.

    Article  Google Scholar 

  26. Edvardsson D, Fetherstonhaugh D, Nay R. Promoting a continuation of self and normality: person-centred care as described by people with dementia, their family members and aged care staff. J Clin Nurs. 2010;19(17–18):2611–8.

    Article  Google Scholar 

  27. Olsson L-E, Ung EJ, Swedberg K, Ekman I. Efficacy of person-centred care as an intervention in controlled trials – a systematic review. J Clin Nurs. 2013;22(3–4):456–65.

    Article  Google Scholar 

  28. National Institute for Health and Care Excellence (NICE). Motor neurone disease: assessment and management (NICE guideline NG 42). London: NICE; 2016. www.nice.org.uk/guidance/NG42. Accessed 28 Apr 2019.

    Google Scholar 

  29. Back AL, Arnold RM, Baile WF, Tulsky JA, Barley GE, Pea RD, et al. Faculty development to change the paradigm of communication skills teaching in oncology. J Clin Oncol. 2009;27(7):1137–41.

    Article  Google Scholar 

  30. Merckaert I, Lienard A, Libert Y, Bragard I, Delvaux N, Etienne AM, et al. Is it possible to improve the breaking bad news skills of residents when a relative is present? A randomised study. Br J Cancer. 2013;109(10):2507–14.

    Article  CAS  Google Scholar 

  31. Lienard A, Merckaert I, Libert Y, Bragard I, Delvaux N, Etienne AM, et al. Is it possible to improve residents breaking bad news skills? A randomised study assessing the efficacy of a communication skills training program. Br J Cancer. 2010;103(2):171–7.

    Article  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. School of Psychology, Curtin University, Bentley, WA, Australia

    Lauren J. Breen

  2. The Perron Institute for Neurological and Translational Science, Perth, WA, Australia

    Samar M. Aoun

  3. Public Health Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia

    Samar M. Aoun

Authors
  1. Lauren J. Breen
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  2. Samar M. Aoun
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Correspondence to Lauren J. Breen .

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Editors and Affiliations

  1. Division of Otolaryngology–Head & Neck Surgery, Department of Surgery, University of California San Diego, La Jolla, CA, USA

    Philip A. Weissbrod

  2. Division of Otolaryngology–Head & Neck Surgery, Department of Surgery, University of Wisconsin–Madison, Madison, WI, USA

    David O. Francis

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Breen, L.J., Aoun, S.M. (2020). A Person-Centered Approach to Breaking Bad News. In: Weissbrod, P., Francis, D. (eds) Neurologic and Neurodegenerative Diseases of the Larynx. Springer, Cham. https://doi.org/10.1007/978-3-030-28852-5_23

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  • DOI: https://doi.org/10.1007/978-3-030-28852-5_23

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-28851-8

  • Online ISBN: 978-3-030-28852-5

  • eBook Packages: MedicineMedicine (R0)

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