Improving prognosis conversations with stroke survivors and their loved ones

So you are just suggesting you can deliver bad news in a more acceptable format. 

NOT GOOD ENOUGH!  You should tell them EXACTLY what research to are sponsoring to solve the problems.

Improving prognosis conversations with stroke survivors and their loved ones

Conversations with stroke survivors and their loved ones about possible lasting impairment can be traumatic, but there's also potential for them to be therapeutic, according to research from The University of Queensland.

PhD candidate Bonnie Cheng from UQ's School of Health and Rehabilitation Sciences said prognosis conversations can trigger mixed emotions of hope and grief, so it's important to know how people would prefer for them to happen.

When stroke is encountered for the first time, it's hard to know what's important and relevant to ask about, especially during that time of crisis immediately after such a serious health event.

During this time, there's also an immense sense of gratitude for the survival of their loved one that seems to stop significant others from asking for more information.

Conversations about prognosis and lasting impairments, like speech difficulties, need to be an ongoing dialogue between health professionals, the patient, and their support network.

It's important for these conversations to be based on a mutual understanding of what improvements are personally meaningful to the patient and their significant others."

Bonnie Cheng, PhD Candidate, UQ's School of Health and Rehabilitation Sciences

A common lasting condition is Aphasia - a language impairment diagnosed in one-in-three people after a stroke.

The research team interviewed people who identified as a significant other of someone with aphasia between three and 12 months after stroke, including spouses, close friends, adult children and parents of someone with aphasia.

"In the interviews, we talked in-depth about their experience of finding out about the prognosis for aphasia, the impact these experiences had on them, and how they would want to get information about prognosis in a perfect world," Ms Cheng said.

"What we found was significant others need to be included in prognosis conversations so that they too can be informed and supported, alongside the patient.

"The prognosis of aphasia is a sensitive issue to address because it often involves having to adjust to long-term difficulties and changes.

"Recovery needs to be looked at holistically in terms of everyday activities that affect the individual, rather than just scores on a language impairment test.

"Even though we can't yet 'cure' aphasia, this research brings us one step closer to talking about recovery in a way that's as informative and as compassionate as possible, so that people living with aphasia can be supported to live successfully with the condition."

Source:

The University of Queensland

Journal reference:

Cheng, B.B.Y., et al. (2022) Prognostication in Poststroke Aphasia: Perspectives of Significant Others of People With Aphasia on Receiving Information About Recovery. American Journal of Speech-Language Pathology. doi.org/10.1044/2021_AJSLP-21-00170.

 

Improving post-stroke recovery conversations

This is wrong on so many levels.  Trying to suggest that you are breaking the bad news you won't recover as a good thing. There is no compassion here.

Not admitting that you totally failed the patient by not getting them 100% recovered.

Tell them the truth, your stroke hospital is completely incompetent in getting survivors to 100% recovery.

Improving post-stroke recovery conversations

by University of Queensland

Credit: Unsplash/CC0 Public Domain

Conversations with stroke survivors and their loved ones about possible lasting impairment can be traumatic, but there's also potential for them to be therapeutic, according to research from The University of Queensland.

Ph.D. candidate Bonnie Cheng from UQ's School of Health and Rehabilitation Sciences said prognosis conversations can trigger mixed emotions of hope and grief, so it's important to know how people would prefer for them to happen.

"When stroke is encountered for the first time, it's hard to know what's important and relevant to ask about, especially during that time of crisis immediately after such a serious health event," Ms Cheng said.

"During this time, there's also an immense sense of gratitude for the survival of their loved one that seems to stop significant others from asking for more information.

"Conversations about prognosis and lasting impairments, like speech difficulties, need to be an ongoing dialog between health professionals, the patient, and their support network.

"It's important for these conversations to be based on a mutual understanding of what improvements are personally meaningful to the patient and their significant others."

A common lasting condition is aphasia—a language impairment diagnosed in one-in-three people after a stroke.

The research team interviewed people who identified as a significant other of someone with aphasia between three and 12 months after stroke, including spouses, close friends, adult children and parents of someone with aphasia.

"In the interviews, we talked in-depth about their experience of finding out about the prognosis for aphasia, the impact these experiences had on them, and how they would want to get information about prognosis in a perfect world," Ms Cheng said.

"What we found was significant others need to be included in prognosis conversations so that they too can be informed and supported, alongside the patient.

"The prognosis of aphasia is a sensitive issue to address because it often involves having to adjust to long-term difficulties and changes.

"Recovery needs to be looked at holistically in terms of everyday activities that affect the individual, rather than just scores on a language impairment test.

"Even though we can't yet 'cure' aphasia, this research brings us one step closer to talking about recovery in a way that's as informative and as compassionate as possible, so that people living with aphasia can be supported to live successfully with the condition."

The study is published in the American Journal of Speech-Language Pathology.

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Explore further

Answering the question 'Will I get better?'

 

More information: Bonnie B. Y. Cheng et al, Prognostication in Poststroke Aphasia: Perspectives of Significant Others of People With Aphasia on Receiving Information About Recovery, American Journal of Speech-Language Pathology (2022). DOI: 10.1044/2021_AJSLP-21-00170

 

 

Inpatient stroke rehabilitation: prediction of clinical outcomes using a machine-learning approach

What world do you live in where predictions to the failures of status quo rehab mean anything to survivors? This gives you enough time to compose your speech on breaking the bad news of the lack of recovery your patients are going to get? Hell, my doctor knew I wasn't going to recover, so he totally ran away and told me nothing. Like this.

Brave Sir Robin Ran Away

 

Inpatient stroke rehabilitation: prediction of clinical outcomes using a machine-learning approach

• Yaar Harari,
• Megan K. O’Brien,
• Richard L. Lieber &
• Arun Jayaraman 

Journal of NeuroEngineering and Rehabilitation volume 17, Article number: 71 (2020) Cite this article

• Metrics details

Abstract

Background

In clinical practice, therapists often rely on clinical outcome measures to quantify a patient’s impairment and function. Predicting a patient’s discharge outcome using baseline clinical information may help clinicians design more targeted treatment strategies and better anticipate the patient’s assistive needs and discharge care plan. The objective of this study was to develop predictive models for four standardized clinical outcome measures (Functional Independence Measure, Ten-Meter Walk Test, Six-Minute Walk Test, Berg Balance Scale) during inpatient rehabilitation.

Methods

Fifty stroke survivors admitted to a United States inpatient rehabilitation hospital participated in this study. Predictors chosen for the clinical discharge scores included demographics, stroke characteristics, and scores of clinical tests at admission. We used the Pearson product-moment and Spearman’s rank correlation coefficients to calculate correlations among clinical outcome measures and predictors, a cross-validated Lasso regression to develop predictive equations for discharge scores of each clinical outcome measure, and a Random Forest based permutation analysis to compare the relative importance of the predictors.

Results

The predictive equations explained 70–77% of the variance in discharge scores and resulted in a normalized error of 13–15% for predicting the outcomes of new patients. The most important predictors were clinical test scores at admission. Additional variables that affected the discharge score of at least one clinical outcome were time from stroke onset to rehabilitation admission, age, sex, body mass index, race, and diagnosis of dysphasia or speech impairment.

Conclusions

The models presented in this study could help clinicians and researchers to predict the discharge scores of clinical outcomes for individuals enrolled in an inpatient stroke rehabilitation program that adheres to U.S. Medicare standards.

Background

Stroke remains one of the leading causes of disability worldwide, with the majority of stroke survivors requiring specialized rehabilitation [1]. Inpatient stroke rehabilitation is a program of medical intervention and targeted therapies, which aims to maximize a patient’s functional recovery and facilitate reintegration into the community [2, 3]. To evaluate progress, clinicians use standardized assessment tools or clinical outcome measures such as the Functional Independence Measure [4] (FIM) for level of disability or the Ten-Meter Walk Test [5] (TMWT) for walking ability. Understanding the factors that affect these outcomes may help clinicians to streamline the treatment plan and efficiently allocate rehabilitation resources [6, 7]. Further, clinicians assess a patient’s functional abilities based on performance in these standardized tests, such as classifying patients as household ambulators or limited community ambulators based on walking speed score from the TMWT [8, 9]. Estimating a patient’s future discharge scores early in a rehabilitation program would help clinicians set realistic rehabilitation goals and anticipate needs for additional care or medical equipment at discharge.
Several studies have investigated predictors of clinical outcomes after acute inpatient stroke rehabilitation [10,11,12,13,14,15]. Their main focus was to predict individual’s ability to perform activities of daily living, as measured by the FIM and the Barthel Index [16], or to predict walking speed as measured by the TMWT [14]. These studies found that the clinical assessment scored at discharge could be predicted based on patient demographics such as age [10,11,12,13, 15] and sex [11], medical information such as the time from stroke onset to rehabilitation admission [11, 13] and the admission score of the predicted outcome [10,11,12,13,14]. However, there are some notable gaps in our knowledge and understanding of these outcomes. Specifically, previous studies have primarily investigated predictors of a single clinical outcome measure, while therapists often use multiple standardized tests to gauge functional abilities. The American Physical Therapy Association highly recommends additional tests [6], including the Berg Balance Scale [17] (BBS), which assesses balance outcomes and fall risk, and the Six-Minute Walk Test [18] (SMWT), which assesses walking endurance and aerobic capacity. Understanding interactions among different clinical outcomes may help identify the tests that provide unique information about specific functional abilities compared to tests that may be redundant or unrelated to those abilities. Second, studies have predicted the discharge score of a clinical outcome using admission scores from a small subset of other clinical outcomes [14, 19]. For example, discharge walking speed has been predicted from admission scores of BBS and the Motor Assessment Scale [20]. Considering additional admission assessments should improve predictive accuracy, while including additional discharge assessments should provide a more comprehensive overview of a patient’s functional outcomes. Finally, previous studies developed predictive models for clinical outcomes using stepwise methods based on the predictors’ significance level (p-value). However, the ability of the p-value to determine the importance of predictors and to output the optimal set of predictors is limited, especially for small sample sizes, small ratio of sample size to predictors, and correlated predictors [21,22,23,24,25,26,27]. Conversely, certain machine learning approaches aim to reduce model error by selecting a targeted set of predictors based on relative importance [28] and incorporate regularization mechanisms to produce more accurate and generalizable predictions [29].
The objective of this study was to use machine-learning algorithms to develop predictive models for discharge scores of four standardized clinical tests (FIM, TMWT, SMWT, BBS) after inpatient stroke rehabilitation. Potential predictors included patient demographics, stroke characteristics, and the scores of each of the four tests at admission. We also investigated the correlations between the clinical outcomes and the predictors, stated the predictors’ significance level and compared their relative importance in effecting the discharge scores.

Optimism linked to lower stroke severity, inflammation

There is zero chance of optimism post stroke when your doctor has ABSOLUTELY NOTHING  that comes close to protocols leading to 100% recovery.  The good news is that only 10% get to full recovery and if you are optimistic it increases to 10%. And this inconvenient fact just seals the correct response is lack of optimism;

Only 10% rehab full recovery?

The latest useless shit here:

Optimism linked to lower stroke severity, inflammation

Date:

February 12, 2020

Source:

American Heart Association

Summary:

Optimistic stroke survivors had lower inflammation levels, reduced stroke severity and less initial physical disability after three months compared to less optimistic survivors, according to the findings of a small study. Previous studies have associated optimism with improved health outcomes for other medical conditions, however, no studies previously assessed if this association exists among stroke patient.

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FULL STORY

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Stroke survivors with high levels of optimism had lower inflammation levels, reduced stroke severity and less physical disability after three months, compared to those who are less optimistic, according to preliminary research presented at the Nursing Symposium of the American Stroke Association's International Stroke Conference 2020 -- Feb. 18-21 in Los Angeles.

In a small study of 49 stroke survivors, researchers examined the relationship among optimism, inflammation, stroke severity and physical disability for three months after a stroke. Researchers said that understanding how these elements relate to or impact one another may provide a scientific framework to develop new strategies for stroke recovery.
"Our results suggest that optimistic people have a better disease outcome, thus boosting morale may be an ideal way to improve mental health and recovery after a stroke," said Yun-Ju Lai, Ph.D., M.S., R.N., the study's first author and a postdoctoral fellow in the neurology department at The University of Texas Health Science Center at Houston.
Post-stroke inflammation is detrimental to the brain and impairs recovery. Optimism has been associated with lower inflammation levels and improved health outcomes among people with medical conditions, however, no prior studies assessed if this association exists among stroke patients.
This pilot study is a secondary analysis of data collected from a repository of neurological diseases. Outcomes included optimism levels from the revised Life Orientation Test, a standard psychological tool for measuring optimism; stroke severity evaluation through the National Institutes of Health Stroke Scale, and levels of inflammatory markers -- interleukin-6 (IL-6), tumor necrosis factor alpha (TNF?) and C-reactive protein (CRP).
As optimism levels increased, stroke severity and the inflammatory markers IL-6 and CRP decreased even after considering other possible variables. However, this was not true of TNF?.
"Patients and their families should know the importance of a positive environment that could benefit the patient," Lai said. "Mental health does affect recovery after a stroke."

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Story Source:
Materials provided by American Heart Association. Note: Content may be edited for style and length.

On Breaking Bad News

Everyone of your doctors should be an expert at this. They have to tell you that they know absolutely nothing about getting you 100% recovered. In fact, YOU have to figure out your recovery yourself. No one in the world knows anything concrete about stroke recovery.
https://jamanetwork.com/journals/jama/article-abstract/2687358?resultClick=1

Walter Klyce, BA¹

Author Affiliations

JAMA. 2018;320(2):135-136. doi:10.1001/jama.2018.8544

“Call home, Dog died.”

The summer after ninth grade, I spent eight weeks on an idyllic lake in the pinky of Michigan, at a camp for artsy teenagers. When I look back on this time, it stands out as a sort of golden summer, full of singing, sunshine, and the best parts of adolescence. I think of myself during those weeks as being close to my best self, and I enjoyed camp so much that I even went back for a second dose the following year. Still, there is one bit of particular sourness that lingers from that first summer; one that, if not for its absurdity, would be heartbreaking.

Mobility Mission is an entertaining online game that addresses post-stroke mobility challenges - National Stroke Association

What a fucking pile of shit.  Rather than solving anything in stroke the NSA does worthless crap like this!  This is why I call them fucking failures of stroke associations.  Just another way to get better at breaking bad news.
http://www.stroke.org/stroke-resources/resource-library/mobility-mission-online-game
Stroke is a serious condition, and learning to deal with the effects of surviving a stroke can be challenging. This game will help you gain a better understanding of post-stroke mobility challenges such as spasticity, paralysis, foot drop, as well as management and treatment options you can discuss with your healthcare provider. As you travel through the four levels of the game you will learn how to improve your safety at home and acquire tips to lower your risk of falling. Your journey is waiting!
Play Now

Motivational Interviewing Post-Stroke: An Analysis of Stroke Survivors' Concerns and Adjustment

Another way to get better at breaking bad news.  Instead of actually solving all the fucking problems in stroke, just tell patients they need to be motivated to recover on their own. WHAT A FUCKING PILE OF SHIT RESPONSE!
http://www.ncbi.nlm.nih.gov/pubmed/25904673

Auton MF¹, Patel K², Carter B², Hackett M³, Thornton T², Lightbody CE², Leathley MJ², Watkins CL⁴.

Author information

Abstract

Our earlier research demonstrated that participation in four sessions of motivational interviewing (MI) early post-stroke has a positive impact on stroke survivors' mood. However, the theoretical underpinnings of MI in supporting adjustment (rather than its traditional use in supporting behavior change) require clarification. This article describes a content analysis of MI transcripts for 10 participants in our previous study, to identify the focus of discussions (patient "concerns") and potential effective components of our MI approach. Patients' post-stroke concerns were shown in 16 categories, including frustration, family impact, and getting well. There was a pattern of change discourse across sessions: "Sustain talk" (reasons for not changing) reduced from Session 1 onward, "change talk" (intent to change) increased then reduced, and "change expressed" (changes achieved) increased from Sessions 1 to 4. MI facilitates healthy adjustment post-stroke in some patients, in turn affecting mood, but clarification of how this effect is achieved requires further exploration.
© The Author(s) 2015.

KEYWORDS:

content analysis; depression; psychosocial issues; qualitative analysis; self-efficacy; stroke; theory development

PMID:

25904673

[PubMed - in process]

Writing Your Way to Happiness

Your doctor could use this as a shortcut to your happiness instead of figuring out how to get you to 100% recovery with proven stroke protocols. Or maybe they want to get better at breaking bad news instead.
http://well.blogs.nytimes.com/2015/01/19/writing-your-way-to-happiness/

The University leads research and teaching into spirituality in health care to give people “hope, meaning and purpose”

For us stroke survivors hope is pretty much out of reach since only 10% get to full recovery. I most definitely am not a spiritual person, yet I have a definite meaning and purpose. I really dislike this focus because it seems to focus on  just another version of getting better at breaking bad news            rather than getting people to 100% recovery. 'We don't know anything about how to get you recovered, but look over here, you can still have a meaning and purpose to life'. Man I hate that type of condescending tripe.

The University leads research and teaching into spirituality in health care to give people “hope, meaning and purpose”

The term ‘spirituality’ is now widely used to describe the qualities that give people hope, meaning and purpose.  In the case of patients, it can aid their recovery.  The University of Huddersfield has become a key centre for research into spirituality and how it can be integrated into health care teaching and practice.
Articles, overseas conference presentations and now close links with an NHS trust are among the recent outputs and activities of the University’s Spirituality Special Interest Group, based in the School of Human and Heath Sciences.  Established for ten years, the group has also run a series of master classes for health and social care practitioners.
Spirituality is embedded in a wide range of undergraduate courses – covering subject areas such as psychology, social work, nursing, physiotherapy and occupational therapy – and four PhD students are currently carrying out research on spirituality in health care.  Also, plans are being made for a 2015 conference on the subject.
Melanie Rogers is a Senior Lecturer and Advanced Nurse Practitioner at the University and one of the leaders of the special interest group, alongside Professor John Wattis and Senior Lecturer Janice Jones. She admits that many people regard spirituality as a nebulous term, or one that is often conflated with religion. However, she says, spirituality is intensely practical.
“It helps to sustain health care workers and patients by recognising and supporting a sense of meaning and purpose in life.  It can improve resilience in patients and practitioners alike, in addition to improving the experience of illness and crisis in patients.”
She acknowledges that for some people, spirituality derives from religious beliefs. But for many others it stems from factors such as their relationships, community connections and special interests.
The University’s special interest group is now a “spiritual partner” of the South West Yorkshire Partnership NHS Foundation Trust, which provides community, mental health and learning disability services in Barnsley, Calderdale, Kirklees and Wakefield.  It has embedded spirituality into its work.
“Spirituality and the practitioners approach to their patients play a huge part in recovery from illness,” said Melanie Rogers, whose recent co-authored articles include an evaluation of therapeutic optimism, dealing with the role played by a practitioner’s belief in a patient’s recovery.
“Patients can lose optimism, but the practitioner needs to try and facilitate it.  One way is to spend time listening to the patient – being fully present and engaged in the relationship. Spirituality is about the patient being the focus and it is very practical, not at all airy fairy, and we know it sustains health care workers and patients,” said Ms Rogers, who has been invited to join the executive of the British Association for the Study of Spirituality.
Her most recent article is ‘Health care lecturers’ perceptions of spirituality in education’, in the leading journal Nursing Standard presenting research carried out at the University originally led by Dr Sharon Prentis, a former member of staff.  Her co-authors were University of Huddersfield colleagues Professor Wattis, Dr John Stephenson and Janice Jones.  Also, Melanie Rogers and Janice Jones have presented at conferences on spirituality that have taken place in the UK and overseas.
Although spirituality is gaining increasing recognition, it is still not spread evenly across the spectrum of health care.
“Occupational therapy has taken a lead, and there is growing amount of evidence in the fields of mental health and palliative care, but many of the other disciplines struggle to know how to integrate it into their care,” said Melanie Rogers.  Research and teaching at the University of Huddersfield aims to correct this imbalance.
http://www.hud.ac.uk/news/2014/november/spiritualityplayshugepartinpatientsrecoveryfromillness.php

Effects of information and training provision in satisfaction of patients and carers in stroke rehabilitation

Another version of  breaking bad news
A much better use of their time would have been to figure out how to stop the neuronal cascade of death. But laziness rules.
http://iospress.metapress.com/content/u760l8114018262q/

Authors

Aizpea Aguirrezabal¹, Esther Duarte¹, Nohora Rueda¹, Cristina Cervantes¹, Ester Marco¹, Ferran Escalada¹

¹Physical Medicine and Rehabilitation Department, Parc de Salut Mar Hospital de l'Esperança, Hospital del Mar. Research group on Rehabilitation, Institut Hospital del Mar d'Investigacions Mèdiques, (IMIM), Universitat Autònoma de Barcelona, Barcelona, Spain

Abstract

BACKGROUND: Active information and training improves patient and carer knowledge of stroke and aspects of patient satisfaction, as well as reduces patient depression.
OBJECTIVE: To evaluate the effect of a post-stroke information and carer training intervention provided in the rehabilitation hospital setting on patient and carers' satisfaction.

METHODS: Nonrandomized, controlled trial with 241 patients consecutively admitted in a post-stroke rehabilitation unit and their carers. The first 140 underwent a standard rehabilitation program (control group) and the 131 following attended an additional class (intervention group). Satisfaction was assessed with the Satisfaction Pound Scale administered by telephone 6 months after stroke in 74 patients and 85 carers from the control group and in 76 patients and 73 carers from the intervention group.

RESULTS: Over 80% of patients in both groups were satisfied with information, care and therapy during hospitalization. The amount of therapy and support at discharge were the issues that arouse greater dissatisfaction. Patient and carers' satisfaction with information, support and accessibility to rehabilitation team after hospital discharge improved after the intervention (p < 0.001).

CONCLUSIONS: Systematic active information, training and community support provision for stroke patients and carers improves satisfaction with stroke rehabilitation programs and support received after hospital discharge.

The effectiveness of problem solving therapy for stroke patients: study protocol for a pragmatic randomized controlled trial

If you were smart you would realize that the whole problem here is that survivors have a small chance of full recovery  using current methods. Making them feel better about the lack of recovery is not useful. Go back and start figuring out how to reduce disability in the first place by maybe using one of these 177 hyperacute therapies.

This is just another version of getting better at breaking bad news.
 http://7thspace.com/headlines/440170/the_effectiveness_of_problem_solving_therapy_for_stroke_patients_study_protocol_for_a_pragmatic_randomized_controlled_trial.html
Coping style is one of the determinants of health-related quality of life after stroke. Stroke patients make less use of active problem-oriented coping styles than other brain damaged patients.

Coping styles can be influenced by means of intervention. The primary aim of this study is to investigate if Problem Solving Therapy is an effective group intervention for improving coping style and health-related quality of life in stroke patients.

The secondary aim is to determine the effect of Problem Solving Therapy on depression, social participation, health care consumption, and to determine the cost-effectiveness of the intervention.

Methods: We strive to include 200 stroke patients in the outpatient phase of rehabilitation treatment, using a multicenter pragmatic randomized controlled trial with one year follow-up. Patients in the intervention group will receive Problem Solving Therapy in addition to the standard rehabilitation program.

The intervention will be provided in an open group design, with a continuous flow of patients. Primary outcome measures are coping style and health-related quality of life.

Secondary outcome measures are depression, social participation, health care consumption, and the cost-effectiveness of the intervention.DiscussionWe designed our study as close to the implementation in practice as possible, using a pragmatic randomized trial and open group design, to represent a realistic estimate of the effectiveness of the intervention. If effective, Problem Solving Therapy is an inexpensive, deliverable and sustainable group intervention for stroke rehabilitation programs.Trial registration: Nederlands Trial Register, NTR2509

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

A much better use of their time would have been spent working on research that provides better outcomes rather than creating the nocebo effect.
http://informahealthcare.com/doi/abs/10.3109/09638288.2012.703757

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.

So rather than coming up with good news, lets become better at delivering bad news. Complete failure.


Read More: http://informahealthcare.com/doi/abs/10.3109/09638288.2012.703757