Friday, October 26, 2012

Breaking the Bad News

Last Thursday, I was tasked to present an interesting case during the monthly Tumor Boards of our hospital. Since this month was also the celebration of the World Hospice and Palliative Care Month, I decided to focus the discussion on how to properly disclose the diagnosis of cancer to our patients.

The case we presented was an actual case of a hospital employee who presented with a cough and was suspected to have lung metastasis and needed diagnostic workup to look for the primary cause. However, the patient had history of anxiety and the relatives are colluding not to disclose the diagnosis until the biopsy is certain. After two weeks, the biopsy was out and we were called in to disclose the diagnosis and the medical plan.

I discussed to the group the procedure we followed in disclosing to the patient and his family. I used the six step SPIKES procedure proposed by Baile, Buckman and Lintze. I explained the importance of preparing a good setting, knowing the patients perception, inviting ourselves and using the patients knowledge in explaining the disease, showing empathy and explaining the medical strategy in handling the condition.

It was overwhelming to receive enthusiastic response especially from the medical consultants from other specialty. Their enthusiasm felt like they found a new ally in battling cancer. We could never overemphasize the importance of giving good patient care especially to our cancer patients. And there is no better way to start showing our love and concern to our patient than in disclosing properly a bad news.