When communicating "bad" news to patients, the following six-step protocol can be useful to guide a family conference. The six steps are to prepare and plan beforehand, find out how much the family knows, then ask how much does the family want to know, share the information, be responsive to the family’s feelings and plan to follow-up.

1. First, prepare yourself and plan what will be discussed by confirming the facts and rehearsing what will be shared. Choose an appropriate setting that is a quiet, private place, allot adequate time, and decide who will attend the meeting and who will lead the meeting.
2. Next, establish what the family understands so far about the illness and discuss goals and expectations that can be hoped for and the patient wants.
3. Before you share any news, ask if the family is ready to hear about the results and establish how much information is wanted. Seek comfort goals and keep the patient as comfortable as possible. Ask if it would it be helpful to discuss prognosis and speak in ranges rather than specifics while balancing hope and realism.
4. Use clear, comprehensible language and give the information in small pieces keeping to only one or two key points.
5. Then, stop and wait. Be prepared for a range of emotions and listen with a caring attitude. Acknowledge the emotions and provide support.
6. Finally, end the meeting by summarizing decisions made using clear language and reassuring the family that the patient will not be abandoned.

Have you recommended to a patient that he or she should lose some weight and start to exercise only to find out on a follow up visit that the patient has not taken any steps to implement the changes? Unfortunately, this scenario is far too common. Changing the way you eat is not just a matter of developing discipline over your eating habits. In order to make healthful eating choices, your body and mind need to work together. This is known as intuitive or mindful eating that involves paying attention to cues that give you information about what and how much to eat. An equally important element to intuitive eating also means being aware of your thinking and emotional moods while eating. Adopting mindful eating entails eating to nourish your body and meet your hunger needs as opposed to losing weight. Additionally, it is one in which you no longer judge yourself based on weight. It also necessitates understanding the emotional triggers that urge you to ignore hunger and body cues and continue to eat despite feeling full. Intuitive or mindful eating is an alternative to the failed yo-yo dieting by having a conscious awareness of your food choices. The Health At Every Size (HAES®) approach does not categorize food as either good or bad. More importantly, HAES® does not use weight loss as a measure of success.It is a weight neutral/weight inclusive approach that emphasizes acceptance of people of all shapes and sizes.

Changes in cognition after anesthesia and surgery may occur in some older adults. Delirium seen in the postoperative period find the majority of patients recover shortly after surgery. However, postoperative delirium has persisted up to three months and, in some cases, longer in about half of older adults. While older age was identified as the most basic predisposing risk factors for ICU delirium, there have been other hypotheses offered to explain postoperative delirium. Among these are the type of surgery and the type of anesthetic used. Additional evidence points to the role of neuroinflammation, metabolic syndrome and the stress of surgery that impact a patient’s cognitive reserve. The functional status of older adults prior to surgery may offer additional guidance as to the level of the risk of postoperative delirium. Regardless of the underlying causes, cognitive changes following anesthesia and surgery that decrease functional independence and quality of life may lead to extended hospitalization and possible skilled nursing needs after discharge. The additional costs of such care only further burdens an already stressed health care system. The need for preoperative evaluation of cognition is imperative to reduce the risk of postoperative delirium among older adults. Thus, there is a need to screen older adults prior to surgery with a minimal burden on the staff or workflow of the organization.

Cognitive decline in older adults may present as attention and concentration difficulties, slowed processing speed and executive dysfunction. The term pseudodementia sometimes gets mentioned as an explanation for cognitive decline in older adults. This term generally implies a depressed state is the underlying cause of cognitive impairment. However, this term is considered antiquated now with better understanding of the reasons for cognitive changes in later life. The more correct diagnosis is mild cognitive impairment. Instead of the cause, late-onset depression is likely a prodrome for dementia. Individuals with late life depression are prone to be diagnosed with dementia within a few years. It was found that the combination of impaired cognitive and depressive symptoms doubles for every five-year increase in age after 70 and is present in 25% of 85-year olds. Neuroimaging shows both deep subcortical grey and white matter lesions suggestive of a cerebrovascular disease plus cognitive impairment. A better model is depression with memory impairment and executive dysfunction. Thus, the presence of depression should not be an exclusion for the diagnosis of dementia. Moreover, there are treatments available for both depression and mild cognitive impairment if identified early.

For the physician, the need to explain the risks and benefits of the different treatments offered requires effective communication. However, effective communication means ensuring that the patient comprehends the information while responding to expressed fears that may impede the processing of the information presented. The patient can also share her or his values with regard to quality of life issues that help guide a person’s decisions. In this way, a patient is encouraged to move from a passive recipient of information to an active participant in her own treatment in order to be more confident in the resulting treatment decisions. Health care providers are looking for innovative methods to provide quality health care to vulnerable populations while reducing disparities in communities with poor access to care and higher rates of disease and death based on race and ethnicity. A patient-centered approach treats the whole person and is responsive to patient values and perceptions of desirable outcomes. Thus, in a shared decision-making process, there is a distinct role for both the patient and provider that emphasizes the preferences and goals of the patient. The use of more patient-centered communication with underserved and vulnerable populations may also increase understanding, lead to better decisions and improve treatment adherence. In addition, to optimize the quality and outcomes of care, use of locally derived and culturally appropriate statistics that explain the effectiveness of various treatment options during a consultation may assist in the shared decision-making process and the best outcome for each patient.

Trauma generally represents two interrelated components: a hazardous event that presents a threat to life goals and an inability of the person to respond with adequate coping mechanisms. Normal people experience normal reactions to a traumatic event. After a traumatic experience, an individual may notice various changes in their mood, behavior and body. Examples of these vary in intensity depending on the person and situation. The most common symptoms associated with trauma are changes in mood, appetite, sleep and energy level, motivation, concentration and focus, ability to do normal daily activities or work, and socialization. Practical assistance can be offered to children and adults by identifying the immediate need, clarifying that need, discussing an action plan and acting to address the need. This helps move an individual from immobility to mobility. A person may meet criteria for a mental health diagnosis when the person’s symptoms significantly affect their daily functioning and quality of life. Prevalent diagnoses after traumatic injury include acute stress disorder, post-traumatic stress disorder, anxiety disorders, depressive disorders and adjustment disorders. In addition, medications such as selective serotonin reuptake inhibitor, or SSRI, antidepressants are effective treatments for the symptoms of stress disorders. Our clinicians utilize evidenced-based psychological practice when providing services to patients and families at UF Health.