Setting up the Meeting – How to Break News

by Mark Hughes, MD, MA

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    00:00 So, here's a methodology, for how to break serious news.

    00:06 Again, you need to be flexible.

    00:08 These are guidelines and not supposed to be, you know, you're going to go step one, step two, step three, step four, and so on.

    00:14 This is a framework to think about, rely on but not be so rigid that you're going to follow it.

    00:21 So it's called the SPIKES method, very common mnemonic that's used for breaking serious news.

    00:28 S is set up setup, P is perception, I is invitation, K is knowledge, E is emotions and empathize.

    00:39 And S is strategies.

    00:42 So we're going to go through each of those steps.

    00:46 So first of all, setting up a meeting.

    00:48 You want this to be a quiet private space.

    00:52 You want to make sure that you can communicate with the patient personally.

    00:56 Now, in today's medicine, there might be times where you need to make a telephone call to a patient.

    01:03 There might be times where you can do a telemedicine encounter.

    01:07 The goals there are still to try to make it as quiet and private as you can.

    01:12 So, if it is a virtual encounter, making sure that they are minimizing the distractions in their environment.

    01:18 If it's in person, you're meeting with the person in a room.

    01:23 Again, you're going to try to get rid of any kind of distractions in the environment.

    01:28 If it's a quiet, like an emergency room, still trying to pull a curtain to make sure that you have sort of a quiet private space with the patient, there might be other noise that's going around, but try to make it as private as you can.

    01:43 Part of this is also going to mean managing time constraints.

    01:46 So knowing how much time you might need to have the encounter not being interrupted during the encounter.

    01:52 That might mean, you know, if you have a paging device or some way that you're receiving messages on your phone, that you're handing that off to somebody so that they can handle those messages, those urgent calls You may be putting your phone on silent mode.

    02:10 So do you don't get those rings and beeps, and so on, that might interrupt with the flow of the conversation.

    02:17 Know how much time you have, and really try to devote as much time as you can to this encounter, knowing that people will react differently.

    02:26 And you might need to budget your time, Figure out before the meeting who needs to attend.

    02:32 So, obviously, you're going to want to be able to talk to the patient, but maybe they're going to want a loved one, a family member, to also participate in the conversation.

    02:42 So, if you anticipate having the meeting, trying to get the involved parties present, and agreed upon a time that you're going to all meet.

    02:54 Then you know, whilst as you're setting up the meeting, you also have to sort of prepare yourself for the meeting.

    03:00 So whatever the news is, how does this relate to the patient's medical history? Whether they've had past or any kind of current treatments that they're currently undergoing, all of those things you want to know, how does this news fit in with that past history of their other diagnoses, or this particular diagnosis, that's now changed in some way.

    03:25 You want to try to recall back to any previous conversations you've had with the patient, maybe was a diagnostic test you sent them for.

    03:32 You sort of prepared them of what you might be talking about, we're going to come back and talk about the results of this meeting is now to talk about that recall those previous conversations, how you've sort of laid the groundwork for this conversation.

    03:47 Figure out for yourself what you'd want to try to accomplish in the meeting.

    03:51 So what your goals are for the encounter? One is sharing the information, but then developing a plan in relation to that information.

    03:59 So you've got some goals in mind, again, you got to be flexible and go with different goals that the patient might bring in the encounter.

    04:05 But you're sort of knowing going in what you want to try to accomplish.

    04:12 You also try to think about, "Well, if I were a patient, or if I've had similar patients with this condition, what questions would they ask? Can you anticipate what they might ask? And then be ready for an answer.

    04:24 Maybe that's reviewing the medical literature, so that you have some some background as to how to answer those questions of the patient.

    04:34 Preparing the room. So we've already talked about the idea of trying to make it quiet and a private space as much as possible.

    04:39 If there are going to be multiple attendees at a meeting, make sure you have enough chairs for everybody.

    04:44 It's always best for these encounters to be sitting down.

    04:47 That gives even an unconscious message that you're going to spend the time to share this information with the patient.

    04:54 When you're standing, they might get the impression, well, maybe you're just hoping to leave the room as quickly as possible.

    05:00 So sitting down is important.

    05:01 If at all possible, make sure you have enough chairs for everybody.

    05:06 You might anticipate that the patient is going to have an emotional reaction.

    05:09 They may get sad, they may get tearful.

    05:11 So having tissues available for them.

    05:13 So knowing that those are in the room already, before you start the encounter is an important idea.

    05:19 As you then think about going into the room to have this meeting, you have to prepare yourself.

    05:24 You have to set your intention of "Okay, I'm going to be present.

    05:28 I'm going to be there with the patient.

    05:32 So, whether you take a deep breath, whether you do some sort of a mindfulness exercise, just make sure you're preparing yourself as you go into the encounter.

    05:42 As I said, it's important to then sit down in the room.

    05:45 So avoid barriers between you and the patient.

    05:48 Try to make it as close as possible.

    05:51 We want to give the appropriate social distance with them, so that they don't feel that they're being smothered but close enough that there are no barriers between you and the patient.

    06:02 That they can see your body language, you can read their body language and respond appropriately.

    06:07 Obviously, when you're starting encounter, just like any clinical encounter, you want to make a connection with the patient.

    06:12 You want to do that with eye contact.

    06:14 Perhaps touch, shaking their hand if that's still done nowadays, in our pandemic year.

    06:21 In some way of making a connection with them, even a verbal expression.

    06:26 Some greeting to show you're welcoming them and looking forward to talking with them.

    About the Lecture

    The lecture Setting up the Meeting – How to Break News by Mark Hughes, MD, MA is from the course Breaking Serious News and Advance Care Planning.

    Included Quiz Questions

    1. Evaluate
    2. Strategize
    3. Invitation
    4. Knowledge
    5. Perception
    1. Setting up the meeting
    2. Strategize
    3. Knowledge
    4. Educate
    5. Induce
    1. Managing time constraints
    2. Inviting an interruption
    3. Asking a secretary to figure out who should attend
    4. Stepping out to take a call from a friend
    5. Having the meeting in a hallway

    Author of lecture Setting up the Meeting – How to Break News

     Mark Hughes, MD, MA

    Mark Hughes, MD, MA

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