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Breaking Bad News: Peds Edition Part 1

Rachel Cramton, MD and Solomon Behar, MD
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Sol and Rachel Cramton, Pediatric Hospitalist and Palliative Care Provider at Banner University Medical Center-Diamond Children’s Medical Center and Associate Professor of Pediatrics at University of Arizona College of Medicine-Tucson discuss delivering bad news to pediatric patients and families.

  • An important general principle when giving bad news to families and patients is to remember that we do not get to decide what is bad news.

  • One of the more common “protocols” for sharing bad news is the SPIKES protocol.

    • S = setting or support

      • Making sure there is somewhere private to sit, having an interpreter if needed, asking the parent who or what they may need for support during the discussion.

      • It is also important to limit the distractions with pagers, phones and/or feeling hungry.

    • P = Perception

      • Asking for the parent/caregivers understanding of what is going on

    • I = Invitation

      • For example, “so is now a good time for me to talk about the labs?” and then you have to honor the answer, even if it is inconvenient

    • K = Knowledge

      • Sharing of information in the way the family would like (“are you a big picture person or a little detail person?”)

    • E = Emotions 

      • Be ready to receive whatever emotions come and then be able to name them

        • Silence can be good but very hard

    • S = Summary and Strategy

      • Summarize conversation and next steps

  • After a difficult conversation, remember to take care of yourself. 

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Hippo Peds RAP December 2021 Written Summary 209 KB - PDF

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