Authors (including presenting author) :
Chun OK, Wong WL, Wong NS, Cheng ML, Chan CM, Fung WW
Affiliation :
The Breast Centre, Department of Surgery, Kwong Wah Hospital
Introduction :
Breast cancer is the most common cancer among women in Hong Kong and the word cancer itself can create negative impact in patient’s life. There are no doubt breast cancer patients experience significant distress at the time of diagnosis. Patients may feel anger, fear of cancer, worry about the treatment plan, their families or their jobs. They may also feel their lives are out of control, hopeless and helpless. Unstable emotions affect the information receiving and patients cannot make up their mind to decide their treatment plan. Besides, doctor need to spend time to settle their emotions during the consultation.
Objectives :
This program aims to alleviate patients’ psychological distress before treatment plan discussion and minimize doctor’s consultation time.
Methodology :
Screen-detected newly diagnosed breast cancer patients and their cases are discussed in multidisciplinary team meeting with confirmed treatment plan are recruited in our program. Patients and relatives are invited to see BCN one hour before doctor’s consultation to disclose the bad news following the SPIKES protocol. It includes building rapport in a proper setting with privacy, determining patient’s understanding and information needs, avoiding use of medical jargon, supporting patient emotions, allowing for questions, summarizing, and determining next steps. A self-reported questionnaire is administered to evaluate the satisfaction on the breaking bad news experience provided by BCN after operation.
Result & Outcome :
From 2018 to 2021, 118 patients were joined this program with 101 patients had operation done in Kwong Wah Hospital. The mean age was 59.97 years old. All of them were early stage and the majority were stage 0 and stage 1 disease. The BCN used 30 minutes in average per patients to break the bad news, settle their emotions and briefly explain the treatment plan. Nearly half of them stated they were tearing or had bad mood feeling during breaking bad news. They agreed the arrangement could allow to express their feelings before treatment plan discussion with doctor and could facilitate the questioning and decision making during consultation. They also agreed the BCN support could smooth out their treatment journey.
Breaking bad news is a complex communication task, using SPIKES protocol can guide BCN to break the bad news, minimize the psychological distress felt by the patients, build up the nurse-patient rapport and facilitate early recovery.
