Giving bad news. Diagnosis: End stage renal disease. Referring care to a specialist (nephrologist)
You will also need to submit a thorough reflection of your experience in order to pass the assignment. If you do not submit the reflection your grade can be severely impacted leading to an assignment failure, even if you attended the session. Your reflection must be at a minimum 2-3 full pages of thorough discussion (excluding the title page). If you only submit 1-1/2 pages or do not write a thorough discussion, you will lose points. The questions below may help you reflect on your breaking bad news experience. You should be able to answer each question in your reflection.
Please put your reflection in paragraph form as you would write a formal paper and DO NOT put the actual questions below in the document. You do not need references as this is your own reflection and you will not cite sources. You may write the paper in first person and you must do the title page for the reflection in student APA 7 format (see student APA 7 format here(Links to an external site). You may lose points if you do not follow APA as this is a requirement when submitting papers in graduate school.
1. How do you think the simulation went?
Well. I was well prepared with the full diagnosis and able to answer her questions smoothly. I explained her diagnosis in laymans terms and she understood the plan of care. She felt supported and heard. She was scared and I showed empathy.
2. Briefly discuss your own emotions and feelings as you delivered the bad news?
It can be very emotional to change someones life forever with the next set of words you will be saying. I was scared that I was choosing the right words. I did not want to say the wrong thing and cause panic or mislead her. I had to refer her to a specialist and I did not know how her body would respond to the treatment plan
3. What were your primary concerns about the actual scenario?
Not show enough empathy. Not provide space and quiet time for her to reflect. Speaking too fast. Using big words. Giving unrealisted or false hope. Giving false information as to what the nephrologist
4. What were your favorite/least favorite parts of the activity? What were you uncomfortable with?
I am comfortable having conversations with patients. Like normal people. Least favorite was the quite silence while I allowed her to process. It was uncomfortable. Along with the actual bad news I had to deliver. Favorit was the fact she was confident in the end we would take care of her
5. Discuss how you addressed the Scope of Practice with your patient during the session.
I basically explained that a specialist will have to take over the care of the kdney disease while I managed the rest of her health problems
6. Did you feel the patient made an impact on the activity? Why or How?
Yes. She played her role well. It allowed me to be in the moment
7. How do you see yourself using the breaking bad news SPIKES protocol in practice?
Look up spikes protocol
8. How did you address 2-3 of Picker’s Principles of Patient-Centered Care and Shared Decision Making during the session? Discuss each in detail.
1) respect for the patient’s values, preferences, and expressed needs; 2) information and education; discussed the diagnosis etc in laymans terms
3) access to care; I made sure she will speak to our office coordinator and arrange transportation to appts and to see if a home health aid would be suited to help her take her meds etc.
4) emotional support to relieve fear and anxiety; comforted and offered empathy
5) involvement of family and friends; invited her husb and when he couldn’t attend said if he wanted to call me after hours when hes available I could explain the steps again to him, and the plan.
9. Discuss your strengths during the simulation and the areas where you feel you could improve.
I was comfortable talking with the pt. slowing my words down could help to improve
10. Briefly discuss the patient debriefing and the faculty debriefing sessions individually. What helped you the most? What was not helpful?
Debriefing with dr Weiss was great. She helped me realize that its ok to not know the answers but when a patient feels heard and offering space for them – they appreciate it more and remember that in these times.
Breaking Bad News Simulation Reflection
On September 15, 2023 I participated in a breaking bad news simulation where I had to inform a patient, Mrs. Smith, that she had been diagnosed with end stage renal disease. Delivering such devastating news to a patient is challenging both emotionally and in ensuring effective communication. This reflection will discuss my experience in the simulation focusing on my emotions, concerns, strengths and areas for improvement.
Emotions and Feelings
It was difficult to remain composed knowing I had to shatter Mrs. Smith’s world with the diagnosis. I felt anxious about choosing the right words and tone so as not to cause undue panic. There is no easy way to tell someone their kidneys are failing. I wanted to be as empathetic as possible while still being truthful and direct. Allowing silence for her to process was uncomfortable but important to respect her emotions. Overall it was stressful but rewarding to help her understand her condition and next steps in a supportive manner.
My main concerns were not providing enough empathy, clarity or hope. I worried about speaking too fast, using medical jargon or giving a unrealistic timeline. It was important to explain the diagnosis and prognosis in simple terms, acknowledge the difficulty of the news and reassure her we would work as a team with her nephrologist on the best treatment plan. I also wanted to be sure not to minimize her feelings or come across as insensitive.
Strengths and Areas for Improvement
I felt comfortable having a difficult conversation and allowing the patient to ask questions. In the future, I could improve by slowing down my speech even more to aid comprehension. It would also help to practice more simulations to gain confidence in my abilities. The faculty feedback highlighted that showing empathy through silence and space for emotions is as important as the medical information conveyed. Overall this was a valuable learning experience that will help me effectively break bad news with compassion in my future practice.
Delivering a terminal diagnosis is challenging but a crucial part of the physician role. This simulation provided an opportunity to hone my communication skills in a low-risk setting. With continued practice and self-reflection, I believe I can help guide future patients and families through devastating news with empathy, honesty and support. This experience will help me honor Picker’s principles of patient-centered care throughout my medical career.