Delivery difficult news to patients is sometimes very challenging to the providers as it involves emotions, stress, anxiety and fear. I’m going to the transition from RN to the provider so I have to face this type of situations very often. Empathy approach, a good listener, staying calm in stress situations as well as maintaining professional attitude are some of the qualities needed in provider during this task. All concerns of patient need to be cleared, the treatment plan should be discussed as well as follow up. SPIKES protocol is helpful for the provider to stay focused in this situation.
In this case, I will get her previous pregnancy history if she has any. I will start with some general discussion as a friendly approach in beginning will help patient to discuss all of her concerns. Based on the 2 consecutive HCG drops, I will initiate a difficult discussion with the patient that progressive decline in HCG as representing, a nonviable pregnancy. I will address the issues of guilt, blame, and grief associated with miscarriage. I will discuss with her need of further transvaginal ultrasound. I will discuss management options, including chemical induction, dilation and curettage, and watchful waiting. I will reassure her by letting her know that spontaneous abortions happen to many women, it will not affect her future fertility.
I will start the conversation with a patient based on her knowledge and by making her comfortable in the room, I will start the conversation by saying I get her biopsy results and then will interpret the results in a language she understands and based on how much she knows about breast cancer. I will reassure the patient that breast cancer is very common in the United States and the prognosis in stage 2 is very good. I will further discuss treatment options that include surgery, chemo, and radiation therapy. I will provide information about resources and support group. Emotional support with time spending with the patient is needed in this case to answer all the questions and concerns of the patient.
In this case, I’m dealing with a teenager, so I need a patience because it may involve lots of anxiety, lack of knowledge and concern about confidentiality. I will reassure her it is a Herpes and it is one of most common STD’s but it is curable. I will explain to her causes of Herpes such as multiple sex partners, previous histories of STD’s, then I will explain her treatment plan which involves Acyclovir 400mg Po 3 times a day for 7-10 days. This will clear up the outbreak she is currently having. I will let her know she can have outbreaks again or may not have but if she again develops outbreak then suppressive therapy can be useful. I will give her instructions to not having sex until her symptoms clear, avoid unprotected sexual intercourse and her partner needs to be evaluated so that he can start treatment.