TALKING ABOUT AN INCURABLE DISEASE TO DO NOT TO DO Follow the SPIKES protocol: S = Setting up: prepare the interview Make sure you have enough time and choose a private place. Ask the patient if they want a family member to be present. Maintain eye contact and pay attention to non-verbal communication. P = Perception: understand how much the patient knows Use open-ended questions to stimulate the patient: How did your illness story begin? , Can you tell me what you were told? , If I understand correctly, you told me that... is that so? . I = Invitation: understand how much the patient wants to know and receive the invitation to be informed Ask: Do you think you need more information about your illness or do you want us to talk about the treatment? . Respect the patient s right to not want to know everything . K = Knowledge: give information Accompany the patient towards understanding the problem (diagnosis, prognosis, therapy). Give information in small doses. Recognise the patient s emotional reactions, responding empathetically and legitimising them. E = Emotions: respond to the patient s emotions Recognise and prepare to manage the patient s emotions. Respond empathetically to emotions. S = Strategy and Summary: plan and summarise Establish a clear and shared care plan. Summarise and verify the patient s understanding of what has been discussed. Do not ignore or minimise the patient's emotions, it is important to recognise and validate the patient's feelings. Do not correct patients' denials (e.g. patient: "No one told me what I have - doctor: "It's not possible"). Avoid becoming too detached or impersonal, maintaining a human and engaging relationship. Do not neglect to report or suggest psychological or group support to help the patient manage the emotional aspect of the disease. Do not impose treatments or solutions without listening to the patient's preferences (even if they conflict with medical prescriptions). ROLE-PLAY PROBLEM A woman is diagnosed with incurable breast cancer. Establish empathic communication Respect patient choices Manage realistic expectations Support the psychological aspect Promote active patient involvement Provide support to the family AIMS Location: medical clinic of the oncology department Breast Unit Characters: woman, oncologist Case-study: The patient is a woman in her mid-40s who has just received the results of some tests for suspected breast cancer. The doctor must communicate the diagnosis of an incurable breast cancer. The doctor is empathetic, professional, and clear, respects the patient's emotions, offers support, and follows the SPIKES protocol. EXERCISE 1 Location: psychotherapy clinic of the oncology department Breast Unit Characters: woman, psychotherapist of the Breast Unit department Case-study: the patient, a woman in her 40s with children, was recently diagnosed with incurable breast cancer. The woman is visibly distressed and confused. The psychotherapist at the Breast Unit welcomes her pain, offers her a space to express her emotions, and proposes a path of psychological support for both her and her family. EXERCISE 2 8.1 HANDS ON 369