Communicating a Childs Diagnosis to the Parents - Literature review Example

Communicating a Child’s Diagnosis to the Parents When a child is diagnosed with a disease such as cancer, it is the obligation of the health profession to deliver the message to the parent in a professional manner. It is obvious that the parent is the first person that recognizes a developmental challenge with their child, therefore, they go ahead to seek treatment. Despite the fact that the parent expects that the findings will go either way, the professional involved should not leave anything to chance. Various studies have been conducted to establish the effect of communication of a diagnosis and have come with recommended modes of communication. Of essence is attempting to balance the perception of the parent. This is because communication of a diagnosis in some instances can cause a trauma. Whether it is a disease or a disability, parents may remain in disbelief, anxiety, despair, or shock while getting in terms with the reality. A health professional has the obligation of communicating the findings of a diagnosis to a parent of a diagnosed child. The medical doctors or the patient’s consultant has often been charged with the task of breaking the news of a diagnosis (Miyaji, 1993). However, other health professionals are also required in order to provide the patient’s parents or care gives with the support required. For example, according to a research conducted by McCulloch in 2004, most of the patients singled out the clinical nurse specialist for their support and availability during the process of coming into terms with the diagnosis (McCulloch, 2004). The role of other professionals especially nurses in the provision of follow-up support cannot be overemphasized. It is paramount that when a health professional breaks the news of a diagnosis, they should go ahead to advise the caregiver or the parent of a child the treatment and support required by the patients (Corkin & Chambers, 2007). Despite the call for professionalism in communicating diagnosis, literature has indicated differences in the approach taken in communicating diagnosis. According to Contro et al (2004) and Bower (2009) some parents have been left in depression by the way the diagnosis news are communicated to them. King (2009) observes that health professionals have adopted personalized methods of communicating diagnosis to parents without adhering to the professionally acceptable strategies. It is quite difficult for the parents to forget the communication relayed to them by the health professional. This causes the parent to carry the emotion for years without getting into terms with the truth. To make matters worse, some professionals go ahead to use professional jargon to communicate the issues surrounding the diagnosis to the parent, this aspect results in a state of confusion where the parent is left with many questions and uncertainties. It is not always the fault of health professionals in communicating information of a diagnosis. When delivering the news of a diagnosis, both verbal and non-verbal cues should be used in order to make the parent absorb the news systematically, however, this is not always the case. The health professional may want to communicate systematically but the parent may draw conclusions immediately and fail to pay attention. The delivery of the news has been shown through research to immensely influence the relationship between the parent and the doctor or any other health professional (Graungard & Skov, 2007). However, the delivery of news of a diagnosis is a major challenge to the health professional; therefore, the parent should be ready to listen without drawing conclusions. According to research studies by Brown (2007) and McNeilly et al (2006), the delivery of news of a diagnosis influences the state of health of the child as well as the way the parent is able to perceive the situation, hence the ability to cope. Furthermore, the communication by the health professional to the parent about the diagnosis remains in their mind for a long time (Craig, 2006). In this regard, a systematic approach to e delivery of the bad news ought to be adopted. The information should be delivered on time, based on facts and should be consistent. In addition, the choice of words by the health professional is of essence; in this regard, they ought to consider the need and preferences of the parent whose child has been diagnosed. Three main approaches have been developed for effective communication of bad news such as the case of a child who has been diagnosed with cancer. The SPIKES protocol (Baile et al., 2000) provides an ideal system of communicating news of a diagnosis. In addition, the use of ABCDE mnemonic (Rabow & McPhee, 2000) as well as the Kaye’s (1996) ten step approach provides an ideal communication system to the parent. According to Rabow & McPhee (1999) when breaking bad news, the mnemonic ABCDE should be followed. First, there should be ‘Advance preparation’; in this case the parent should be prepared to receive the news, an aspect that helps them to avoid overreacting to the news. Secondly, there should be a ‘Build of therapeutic environment’. Thirdly, the health professional is obliged to ‘Communicate well’. Fourthly, there is the need to consider how to ‘Deal with patient and family reactions’. Finally, the health professional should ‘Encourage and validate emotions’. Adherence to these steps promotes the process of receiving the bad news and ensures that the parent to the child is not traumatized. On the other side, Kaplan (2010) addresses the SPIKES model that is meant to help in communicating the news of a diagnosis to the parent of a child. The approach involves six steps that should be followed systematically. This model was preferred for cancer patients. The first step involves ‘Setting up the interview’, an aspect that entails creating a conducive environment for effective communication. Step two involves the assessment of the parent’s (patient’s) ‘Perception.’ Here the health professional should be very tactical in getting to understand how the perception of the person to whom the news is delivered. Thirdly, the health professional should ensure that they obtain patient or parent’s “Invitation’. Fourthly, the parent is supposed to be given ‘Knowledge and information’, which helps them to come into terms with the results of the diagnosis. Fifthly, the parent should be supported and have their ‘Emotions addressed with empathy.’ Finally, the health professional provides the ‘Strategy and the summary. Kaye (1996) provided a ten-step model in an effort to provide a mechanism of breaking news of a diagnosis as well as other bad news. The steps are very important to health professionals that fumble with the problem of devising a communication strategy for delivery of bad news. Each step is significant in the process and should not be avoided. Step one involves the preparation for the communication. Thereafter, the health care professional endeavors to understand what the parent of the child knows. Then, the professional establishes the need for more information. If it is needed, the professional should go ahead to provide the information. Then, the professional can give a warning that takes the parent to step of denial. Further explanations are given and the health care professional takes time to listen to the concerns of the parent. Thereafter, feelings are allowed to ventilate while also providing a summary of the communication. Finally, the professional should go ahead to provide additional support that the parent will require for them to come into terms with the news of diagnosis. Considering all the three theories that have been put forth towards the communication of news to the parent of a diagnosed child, four steps are evident. Firstly, the preparation phase is clearly highlighted. In this case, the health professional is obliged to take responsibility and communicate the news within the shortest time possible. In addition, the professional should be confident and well prepared when approaching the parent. It is important that when more than one professional is involved, they should clearly understand their roles. It is also important to understand the parent’s situation and weighing their anticipated perceptions. The information should be relayed in a private place where and should be done through a face-to-face communication. The second step involves communication and entails the delivery of the news confidentially and articulately. It is paramount to be courteous and friendly, this ensures that a friendly environment is created for effective communication. This allows the parent to give their feedback on the information communicated to them. Arising questions should be answered honestly and conveniently. The health professional should leave no stone unturned. After the bad news are delivered planning provides the parent with the capacity to think about the way forward and not remain stuck in the situation. The health professional should develop propose a plan to the parents and ensure that they come to a consensus on the implementation of the plan. In addition, the profession should ensure that a connection is established with the parent in order to facilitate future communications. Finally, follow up is key since it ensures that the parents are able to come into terms with the condition of the child. They are facilitated to get out of the denial phase to the acceptance stage. Some basic communication components should be strictly followed when communicating to a parent concerning their child’s cancer condition. In the first place, it is paramount that the health care provider should be honest, empathetic while they should also prevent any speculative information. Communication is a two-way thing and hence the parents should be listened to keenly. All the questions by the parents should be answered while all the concerns and comments should be addressed. The parents should be availed with all the necessary information on the diagnosis and how the prognosis process has to be effected. The parent should be made aware of the way forward since it helps them move forward despite the bad news. Brown (2007) has pointed out that the parent should be guided on being positive on the situation. In certain situations, miscommunication brings forth anguish to the parents when the process is not properly followed. According to Davies (2002), a complex situation can create a situation where there is a misunderstanding between the parent and the health care professional. For example, in a situation where cancer cells have metastasized, the parent may end up doubting the prognosis of the condition. This is because of the perception that once metastasis has occurred, chances of survival are minimal. When the health professional conveying the news have inadequate training on communication with the patient or the family members on the diagnosis, they are unlikely to deliver (Buckman, 2005). Ben Natan et al (2009) notes that delivery of bad news can be affected by factors outside the control of the health professional such as tiredness, previous experience, working pressure among other personal related factors. The sensitivity of diagnosis information provides that the most relevant parties share it firstly. In most cases, the parents of a child diagnosed are the one who the information is communicated to. In addition, sharing of such information is discouraged from being shared to children. Wright et al (2009) has established that exposing children to diagnosis information may end up invoking thoughts that may traumatize them. It is important that the information is first communicated to the parents and then they are given time to come in terms with the reality before the children are made aware (Prince et al., 2006). Despite the interventions by the medical staff, it is important that they remain within the confines of the law. Different countries have enacted laws that define how communication is conveyed to the patients pertaining their conditions. In conclusion, the communication of diagnosis by healthcare professionals should be well thought of and executed effectively. Of essence is the need to prepare the parent for the communication, then they are communicated to in a clear way with absolute honesty. While the parent is the most suited person to have the news conveyed to, a caregiver can also be considered. Upon effective communication, planning for the way forward should be done while a follow-up should ultimately be done. It is not easy to convey diagnosis information, therefore training of heath care professionals is mandatory. References Baile, W., Buckman, R., Lenzi. R., Glober, G., Beale, E. & Kudleka, A. (2000). SPIKES- a six step protocol for delivering bad news: application to the patient with cancer. Oncologist, 5, p.302-311. Ben Natan, M., Shahar, I. & Garfinkel, D. (2009). Disclosing bad news to patients with life-threatening illness: differences in attitude between physicians and nurses in Israel. International Journal of Palliative Nursing, 15 (6), p.276-81. Brown, E. (2007). Supporting the child and the family in pediatric palliative care. London: Jessica Kingsley Publishers. Buckman, R. A. (2005). Breaking bad news: the S.P.I.K.E.S strategy, Community Oncology, 2 (2), pp.138-142. Contro, N., Larson, J., Schofield, S., Sourkes, B. & Cohen, H.(2004). Hospital staff and family perspectives regarding quality of pediatric palliative care, Pediatrics, 114 (5), pp.1248-52. Davies, R. (2003). Establishing need for palliative care services for children/young people. British Journal of Nursing (Mark Allen Publishing), 12(4), 224. Kaplan, M. (2010). SPIKES: A Framework for Breaking Bad News to Patients With Cancer. Clinical Journal Of Oncology Nursing,14(4), 514-516. McCulloch, P. (2004). The patient’s experience of receiving bad news from health care. Professional Nurse, 19 (5), pp.276-280. McNeilly, P., Price, J. & McCloskey, S. (2006). Reflection in children’s palliative care: a model. European Journal of Palliative Care, 13(1), pp.31-34. Miyaji, N. (1993). The power of compassion: truth telling among American doctors in the care of dying patients. Social Science Medicine. 36, pp.249-264. Rabow, M. & McPhee, S. (2000). Beyond breaking bad news: helping patients who suffer. Student BMJ, 8, pp.45-88. http://eds.b.ebscohost.com/eds/detail?vid=12&sid=aee2ca9e-cdcc-4da3-b9fd-8e20908b7119%40sessionmgr113&hid=110&bdata=JnNpdGU9ZWRzLWxpdmU%3d#db=edo&AN=2905955 Wright, B. B., Aldridge, J. J., Sloper, T. T., Tomlinson, H. H., & Miller, M. M. (2009). Clinical dilemmas in children with life-limiting illnesses: decision making and the law. Palliative Medicine, 23(3), 238-247. http://eds.b.ebscohost.com/eds/pdfviewer/pdfviewer?sid=aee2ca9e-cdcc-4da3-b9fd-8e20908b7119%40sessionmgr113&vid=11&hid=110 Read More