Role of Nurse Practitioners in Delivering Bad News

Communicating Bad News in Palliative Care

Ever increasing attention has been given to the workforce shortages in healthcare, with special attention in the area of palliative medicine. The success of palliative care in a relatively short time has resulted in approximately 90% of hospitals having palliative care teams. However, the increasing demand for palliative care has come at a time of significant shortages of physicians to meet these needs.

Fortunately, the expanding workforce of advanced practice nurses, primarily nurse practitioners (NPs), is filling an important role in palliative care. NPs are key members of interdisciplinary palliative care teams in both inpatient and outpatient settings. In these roles, NPs are increasingly involved in communicating with patients and families, including breaking bad news.

A recent study^[1] evaluated the use of qualitative interviews by NPs who were trained to use a standard communication protocol known as SPIKES when communicating bad news to patients with cancer. SPIKES is a six-step approach that includes:

S—Setting up
P—Assessing the patient's perception
I—Obtaining the patient's invitation
K—Giving knowledge and information to the patient
E—Addressing the patient's emotions with empathic responses
S—Strategy and summary^[2]

NPs were trained using the SPIKES protocol and then interviewed after 30 days of using the protocol in patient care. Interviews with the NPs identified positive opinions about the SPIKES protocol, their training, and their plans to continue to use the protocol in the future. NPs also voiced the need for continued education in communication skills. The authors concluded that educating oncology NPs in using the SPIKES protocol when delivering bad news has the potential to make a positive impact on the experiences of both NPs and patients.

Viewpoint

The topic of breaking bad news to patients facing serious illness is one of the most common issues addressed in palliative care literature. Most of that literature has focused on the role of physicians in delivering bad news. This article provides a new perspective in focusing on the role of NPs in communicating bad news using a standard communication protocol.

Numerous studies have evaluated communication skills training for physicians and the lack of such training or evaluation of outcomes for nurses.^[3,4,5] One of the very interesting aspects of this study is the authors' use of the National Cancer Institute (NCI) conceptual framework for patient-centered communication.^[6] The NCI framework articulates aspects of effective communication to reduce patient suffering. The six core functions of this communication are fostering healing relationships, exchanging information, responding to emotions, managing uncertainty, making decisions, and enabling patient self-management.

This is an important article that speaks to the increasing role of NPs in palliative care. There are tremendous opportunities for nurses to contribute as providers of palliative care at a time when an aging and chronically ill population needs it.

Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Role of Nurse Practitioners in Delivering Bad News - Medscape - Oct 21, 2016.

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