Delivering devastating news to patients
WHEN doctors deliver life-altering news to patients, such as a timeline within which they might die, psychiatrist Dr Saphire Longmore says it is critical that the information relayed is accurate and the necessary support systems are in place.
She noted that while it is not something doctors might have to do often, patients on the receiving end of such information can react differently to the news, and emphasised the importance of ensuring that a mental health professional is present.
“First and foremost, you would want to ensure that you are sure that this information that you are conveying is, indeed, what is likely.
“At the end of the day, we always underscore that any possibilities are there that we have no recourse from it, because the person hearing that now, especially at an age where they would normally be exploring life and they would normally be looking forward to the years of productivity and perhaps family and so forth, to hear that that is shortened or limited in some way is clearly impacting and clearly devastating news,” Longmore told the Jamaica Observer.
She noted that after receiving such news, patients might start to question the legacy they are leaving behind or reflect on the life they have lived, an act that might have some wanting to create a bucket list to make the most of their last moments or become suicidal.
“Persons can go into depression, anxiety, or have trauma. It could be a traumatising situation for them to face such news and be especially unprepared, and so it’s really important for clinicians to do it as sensitively as possible,” she said.
Longmore added: “Prepare the environment, and do it in the right time and place, making sure you have time to do it and you’re not doing it between tasks that you have to rush through. Allow for whatever questions that may come, and also think about who should be present, who should be there in the same space while you convey it, if anyone at all.
“Clearly, this is something that you have to consider, not only the person’s age and mental capacity to deal with the situation, but also who could be there to help make the process easier,” she continued.
The psychiatrist also encouraged medical professionals to use clear and direct language so that the patient is clear on the information they are receiving.
“You don’t want somebody misunderstanding what is being said to them…A technique that we do is to ask them to repeat what was said to them to ensure that they’re understanding it and recognising it, doing little checks throughout the session, throughout the time with them to check on their emotions, check out how they are responding, their state of mind and their presence,” she urged.
Longmore cautioned doctors about giving false hope or answering questions with information they are not too sure is correct.
As each individual is different and may react differently to the news, depending on his or her circumstances, she urged medical professionals to also be unique in their approach.
“You have to recognise that each case is unique and it’s different depending on whatever diagnosis that you’re dealing with, the individual that you’re dealing with, the circumstances of support that might be present, the state of mind of the caregivers or even the parents themselves.
“By all means, you want to ascertain that the patient is of a mental competence and capacity to understand what is being told to them, and if they are, indeed, a child, I would imagine that you would want to, just as how they are under the guidance and there is the concept that any procedure needs to be done with them would need to be signed by a caregiver or parent, I think, likewise, something of this nature you would want to involve those individuals in the process of communicating that information to the patient,” she told the Sunday Observer.
To the patients on the receiving end of the news, she urged them to try and maintain a positive mindset and use the time to prepare for when the day comes, as well as see how they can make the most out of the situation.
“The mindset that you may want to have is one where I am going to make the best of whatever I am dealing with…Prevention is better than cure, but preparation is always the best prevention, so as best as you can, have a holistic approach to everything — physically, mentally, socially, and spiritually,” said Longmore.
“At the end of the day, I would imagine trying to tap into the things that make one happy, that bring laughter, joy, and peace would be top of the list and would be what I would encourage for that individual who might be facing that circumstance,” she said.