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General Discussions

Delivering Difficult News

By Lisa Schulmeister, MN, RN, ACNS-BC, OCN, FAAN
Johns Hopkins Sidney Kimmel Comprehensive Cancer Center staff noted that clinicians often are at a loss at what to say when delivering difficult news. The Hopkins staff explored what to say to be truthful but not take away all hope. They noted a 2008 study, in which
57% of randomly surveyed adults said they believed intervention by God could save a family member even when the patient’s clinicians informed them that treatment is futile.

In order to help clinicians in this common situation, the Hopkins team of physicians and an RN created a conversational tool called AMEN (affirm, meet, educate, no matter what) to provide an alternative to challenging the patient’s beliefs, remaining silent, or changing the subject. The AMEN process affirms hope while maintaining the clinician’s role as provider of care and provider of accurate information. The first step is to affirm the patient’s beliefs and validate whatever the patient’s says (e.g. “I, too, am hopeful.”). The next step is meeting the patient and family where they are in their beliefs (e.g. “I join you in hoping/praying for miracle.”). Next, education is provided (e.g. “I need to discuss [topic];” where the topic is a difficult conversation such as informing the patient of disease progression, recurrence, etc.). Lastly, no matter what, the patient is assured that his or her healthcare team is committed (e.g. “no matter what, we will continue to be with you.”). The Hopkins staff noted that using the AMEN process demonstrates that the healthcare team joins patients on their journeys and helps sustain hope even in difficult times.

Cooper RS, Ferguson A, Bodurtha JN, et al. AMEN in challenging conversations: bridging the gaps between faith, hope, and medicine. Journal of Oncology Practice; 2014; published online before print May 6, 2014, doi: 10.1200/JOP.2014.001375.
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