BREAKING BAD NEWS: MULTIPLE SCLEROSIS - PasTest

Communication Skills and Ethics: Breaking Bad News – Multiple Sclerosis• The patient should be given small pieces of information in a logical manner; pauses are essentialand give the opportunity for questions.• Patients can be given too much information in one consultation after receiving bad news. It ispreferable to establish one or two key points.• Further consultations can address more detailed information. They may choose to bring a friendor relative.Scenario BThe patient is suspicious that MS is the cause and knows a great deal about it.• A discussion about exactly what she understands and expects is important.• The Press tend to report the more disabling end of the disease spectrum, heightening patientanxiety.• Emphasise the variable progression of the disease. Often remitting/relapsing. There can be longperiods with few symptoms. Few patients progress rapidly.• Discuss available treatment options such as steroids and interferon (in outline only).• Discuss the implications for pregnancy and whether this should be pursued– MS has no effect on fertility and does not affect pregnancy outcome.• Reassure her that it is not hereditary.What does he understand might be wrong?Finishing• Summarise what has been discussed• Ask if there is anything that she would like repeated or if she has any questions• Arrange follow-up and put her in touch with relevant support groups.Discussion• Patients do not absorb masses of information from consultations. This is worse in stressful,anxious situations. For this reason it is preferable to give and repeat a little information well, to2 PasTest Ltd © 2012