Pediatric Palliative Care

COMMUNICATION:
Breaking Bad News
dr. Edi Setiawan Tehuteru, Sp.A(K), MHA
 What are the topics?

• Diagnostic procedure
• Staging procedure
• Diagnosis and the stage
• Treatment - including side effects
• Prognosis
• Treatment response
• Palliative
• End of life
 Barriers…

• Misunderstanding
• The ability to deal with emotions that do not
occur as the should
• Information receive is not the same as
information given
• Difficulties in remembering all the information
• Room: quite, personal, and comfort
• Time: arrange a right time, don’t have impression
that you want to finish it in a hurry, turn off cellular
phone
• Relation: no desk between patient and doctor,
straight and maintain eye contact
• Message: master what is being discussed, don’t
delegate to a not right person, realize the
importance of family talk to the doctor, give
information accurately
 Communicating about Death with
Children

• Use a simple language

• Give information over and over again
• Don’t take over the role of parents
• Doctor’s role is to help parents to talk and
spend good quality of time with the child
SPIKES
Objectives

• To describe the 6 steps of the SPIKES

model for giving bad news
Aspects of communications

1. Development of shared knowledge

2. Establishes relationships of mutual trust,
caring, respect
3. Allows for supportive, shared decision
making
SPIKES
SPIKES:
6 steps for communicating effectively
Spikes Model 6 Step Protocol
Setting: Getting started 1. Set the Stage
Perception 2. What does the patient/family
know

Invitation 3. How much does pt/family

want to know?

Knowledge 4. Share the information

Emotion 5. Respond to feelings
Subsequent 6. Plan next steps, follow up
Step 1 - Setting

• Private
• No distractions
• The “right” people – hospital members
and family
• Consider whether or not to include the
child
• Tissues
Step 2 - Perception

• How much does the patient/family know

– “What do you think is going on?”
Step 3 – Invitation

• Reflection on personal and professional

interdisciplinary educational experiences
• Social activities within the
interdisciplinary learning format
Step 4- Knowledge

• Just say the news

• Clear and direct language
– Avoid euphemisms
– Avoid ambiguity
• Use “I wish” and “I am worried”
Step 5 - Emotions

• It’s OK to show your emotions

• Remember to respond to family’s
emotions
– “This kind of information can be difficult to
hear. Can you tell me how you are feeling?”
– Listen and be present
Step 6 – Summarize and
next steps
• Summarize what was discussed
• Make a plan to meet again
• Maintain hope without downplaying the
news
• Offer reassurance that the conversation,
care, and relationship will continue
Thank You