1. https://www.caregiver.org/connecting-caregivers/services-by-state/?state=indiana
2. https://caregiveraction.org/family-caregiver-toolbox
3. https://lotsahelpinghands.com/
4. https://www.caregiver.org/caregiver-resources/caring-for-another/
5. https://www.caregiver.org/caregiver-resources/caring-for-yourself/
Please address the following in a Word document:
1. Please review the services provided by Indiana and reflect. Please connect your reflection to what we discussed in class and how this information could be helpful for you now or in the future. (This pertains to Link 1).
2. Please review 4 boxes within link two and reflect. Please connect your reflection to what we discussed in class and how this information could be helpful for you now or in the future.
3. Please explore link three and reflect. Please connect your reflection to what we discussed in class and how this information could be helpful for you now or in the future.
4. Please explore one caregiving topic within link four and reflect. Please connect your reflection to what we discussed in class and how this information could be helpful for you now or in the future.
5. Please explore one topic within link five and reflect. Please connect your reflection to what we discussed in class and how this information could be helpful for you now or in the future.
Patient-Provider: Discussing Bad News &
End of Life Communication
Day 1 7
Agenda PPC-Discussing Bad News & End
of Life Communication
Activity
Homework
Provider Skills for (PCC)
Active listening Therapeutic interviewing Advice giving Empathy Bad news delivery
1. 2. 3. 4. 5.
Bad News Delivery as the process of health care providers presenting unfavorable medical information or
diagnoses to patients and/or their families that likely is unwelcome or disturbing
patients or patients’ families should not be given false hope, but instead must be presented
with accurate and truthful information
(Mattson & Hall, 2011)
Setting the environment of the health communication exchange and creating a
maximally conducive situation for the delivery of bad news
location of conversation is important to consider
quiet location
eye-level should not appeared rushed
block out potential interruptions
sustained eye contact & touching arm
(Mattson & Hall, 2011)
Perceptions of Health Status
determining perceptions of
health status allows health care
providers to correct any false
information and provide needed
explanations
reveal patients’ and/or their
families’ technical knowledge
of their health situation as
well as their emotional
condition
(Mattson & Hall, 2011)
feelings about the state of an individual’s own health or the health of another
providers talk with patients and/or families about how much
information and in how much detail they would like to know about
their health and by what means they would prefer to receive that
information
respects that patients and their families are unique and
have different informational needs and desires
Invitation
(Mattson & Hall, 2011)
Knowledge
consider medical knowledge of
recipients
provide information in small chunks check of level of understanding
and emotional state
when the bad news is told to patients and/or their families
can provide a warning “I am sorry to have to tell you…”
“Unfortunately…”
avoid being excessively blunt
“You have cancer and have weeks to live” (Mattson & Hall, 2011)
Providers must be aware of patients’ and/or families
emotional responses whether overt (crying) or more
introverted (silence)
Providers need to name or identify the emotions expressed to
themselves. If unsure, ask patients/their families
Providers should identify reasons for the emotions
“My patient is scared because the radiation did not shrink the tumor”
Providers should voice an empathetic response that names
and validates patients’ and/or their families’ emotions
“I understand that you are feeling frightened because of the poor
test results”
1.
2.
3.
a.
4.
a.
Emotions/Empathy
Four-Step Technique for Responding to Emotions and
Providing an Empathetic Response
address and respond to patients’ and/or their families’ emotions
while expressing empathy
(Mattson & Hall, 2011)
Summary provide a summary of the information provided & present a
strategy for future treatment
focus on creating a mutual plan for
making the patients and/or families
as comfortable and contented as
possible
focus on creating a mutual plan for
making the patients and/or families
as comfortable and contented as
possible
(Mattson & Hall, 2011)
Key Points from Brandt (2013)
“However, sometimes when patients ask a direct question, they’re less sure they want a direct answer. So one of the things I try to do is make sure the patient actually wants the information he or she is asking for, and whether the timing and setting are correct. Often when probed, patients are not ready to hear difficult information, or they might need some time or a loved one present.”
(Brandt, 2013, para. 5)
(Dr. Kavitha Jennifer Ramchandran)
“Ask permission. Patients can tell me whether they’re ready to receive certain information.” “Establish a comfortable setting. No one can talk when they are in pain or uncomfortable.” “Make sure the right players are in the room. Some patients can’t make a decision without their partner, a parent, or a child present.” “If patients don’t want information, find out who they want us to communicate with. Establish a surrogate decision- maker.”
1.
2.
3.
4.
(Brandt, 2013, para. 7)
(Dr. Kavitha Jennifer Ramchandran)
“I usually provide a care map or plan with clear lefts and rights. I let people know that I have a certain number of tools in my toolbox but at some point, those tools will no longer be effective and the disease will become more difficult to control. I try to focus on the “disease” rather than the “fight” because basically even with all of our best efforts, some of these diseases are not curable. This isn’t the fault of the patient or the physician.”
(Brandt, 2013, para. 11)
(Dr. Kavitha Jennifer Ramchandran)
“Absolutely. Their journey is just beginning, while their loved ones’ journey is ending. It’s a different path and struggle. The same questions and rules apply around information giving, kindness, and making a plan.”
(Brandt, 2013, para. 14)
(Dr. Kavitha Jennifer Ramchandran)
”
(Brandt, 2013, para. 19-20)
“Be humble. We’re not in their shoes. Be kind. Do unto others as you would want done to you. Listen carefully. A hug is okay in the right setting. It’s okay to cry at times… Cancer sucks.”
“At the end of the day, find the things that keep you whole and happy… It will let you do all the right things again the next day.”
(Dr. Kavitha Jennifer Ramchandran)
(Dr. Kavitha Jennifer Ramchandran)
KEY POINTS FROM NGO-METZGER ET
AL. (2008)
Li et al. (2020) Malhotra et al. (2020) RA 10 Due by 11:59 pm ET Podcast
PATIENT- CAREGIVER
COMMUNICATION Day 18
AGENDA Review Li et al. (2020) Malhotra et al. (2020) Activity Homework
1. 2. 3. 4. 5.
WHAT & WHO ARE CAREGIVERS?
(Wittenberg et al., 2017)
FAMILY CAREGIVER COMMUNICATION
(Wittenberg et al., 2017)
FAMILY CAREGIVER COMMUNICATION
(Wittenberg et al., 2017)
FAMILY CAREGIVER COMMUNICATION
(Wittenberg et al., 2017)
FAMILY CAREGIVER COMMUNICATION
(Wittenberg et al., 2017)
LI ET AL. (2020) (PP. 4-6) “Cancer Patients & Caregivers have diff COM needs”(p. 1)
Target (WHO-wish to talk with) Healthcare professionals Peers Patients Caregivers ETC **decide with whom and when to talk and context
Content (WHAT-they wish to talk about) disease-related info
reducing symptoms (pain & breathing), emotional management (anxiety & fear)(CAREGIVER NEEDS) diagnosis(results), treatment, rehab, and prognosis (PATIENT NEEDS)
emotional support providing empathy & emotional convos (CAREGIVER NEEDS) cared for, supported, understood, encouraged, (PATIENT NEEDS) diagnosis and final stage
daily life breast, ovarian & rectal cancer
info about eating, exercise, and maintaining a healthy weight
metastatic breast cancer normal working life maintain QOL
head and neck cancer using the bathroom
sex/fertility about sex history (diagnosis) (PATIENT) fertility after diagnosis (PATIENT)
death clarify knowledge of death & how to COM with the patient (CAREGIVER) widowers talk about death-prepare to say goodbye (CAREGIVER)
“Cancer Patients & Caregivers have diff COM needs”(p. 1) Style (HOW-COM style)
honesty, compassion, patience, respect, and balance btw truth and hope (BOTH) empathy, competence, honesty, patience & respect (PATIENTS) empathy and sincerity (BOTH) struggled with authenticity and hope balance (BOTH) Australia-providers use direct language about death (PROVIDERS) ability to ask questions easy words to understand importance of delivery (caregiver and provider, step by step from providers to patients) personalized advice diff com for diff stages of cancer diff COM channels (FTF, a phone call- older) (social media and the Internet)
Timing (WHEN-COM timing needs) info early on (BOTH)
say goodbye before things are needed
when things become bad
LI ET AL. (2020) (P. 6) (CONT.)
MALHOTRA ET AL. (2020) oncologist-patient/caregiver communication intervention
TEAMS “training oncologists and empowering patients in effective communication during medical consultation in Singapore” (p. 1)
Feasible & acceptable to oncologists Improved more empathic responses (oncologists) Improved oncologist-patient/caregiver
prognosis goals of care frequency
RA 11 Due by 11:59 pm ET Work on Podcast Communicate as a Caregiver Communication Tips
Professional Issues in Nursing
Professional Issues in Nursing