Breaking bad news in stroke rehabilitation: a consultation with a community stroke team

Abstract

Purpose: Within stroke care clinicians are frequently required to break bad news to patients, however, formal training and guidance remains limited. This article provides a case example of a multidisciplinary stroke rehabilitation team consultation, and aims to contribute towards an evidence base and a model of training for breaking bad news (BBN) in stroke care. Method: The stroke rehabilitation team requested clinical psychology consultation to help with difficulties they were experiencing in BBN to patients. The consultation comprised an assessment of the request, development of a proposal, delivery of a workshop on BBN and an evaluation of consultation impact. A collaborative consultation model underpinned the work, which aimed to empower and facilitate the team to generate solutions by drawing upon their existing expertise. Results: The consultation was found to meet the team’s expectations and needs. Consultees reported increased confidence to communicate difficult messages to patients and rated the consultation highly. A follow-up review indicated the consultation had led to changes in practice. Conclusions: Communication skills are central to BBN effectively. Clinicians may be supported to recognize their existing skill set and increase confidence in their ability to break bad news through a process of collaborative team consultation.

Implications for Rehabilitation

• Despite a lack of formal guidance stroke care clinicians are frequently required to break bad news to patients.

• Clinicians may be supported to increase confidence in their skills to break bad news through a process of collaborative team consultation.

• Developing an evidence base and training in breaking bad news should be considered a priority in stroke care.

Keywords::

• Breaking bad news
• communication
• consultation
• stroke rehabilitation

Acknowledgements

The consultees are to be thanked for their generosity in allowing a report of the consultation to be published in order to inform further developments in consultation practice and clinical support of those with stroke.

Declaration of Interest: The authors declare no conflicts of interest.

Appendix

Appendix 1: Initial consultation meeting semi-structured interview schedule.

What is the problem/topic for consultation?

Who is the person making the request?

How did it come about?

Is the problem shared by the whole team?

Tell me a bit more about the service you provide:

What are the initial target problems and goals?

How would you like the consultation to be delivered?

Who will participate?

Where will it take place?

What impact do you hope the consultation will have on future practice?

How will you know that the consultation has been successful? How might this be measured?