PE24.22-23 | Emergency Communication and Consent — Summary & Reflection

KEY TAKEAWAYS

Emergency communication and consent in paediatrics:
• Breaking bad news — SPIKES: Setting (private, sit), Perception (what do they know?), Invitation (ready to hear?), Knowledge (plain language, warning shot, pause), Emotions (acknowledge before continuing), Strategy (clear next steps, document)
• Silence is therapeutic — pause after the key sentence; do not fill the silence with information
• Valid proxy consent for a child under 18: parent/legal guardian (Guardians and Wards Act 1890); five elements (disclosure, understanding, voluntariness, capacity, authorisation)
• Assent: seek from children approximately ≥7 years; especially important for adolescents, though legal consent remains parental
• Emergency exception: proceed without prior consent when delay would cause irreversible harm AND proxy is unavailable; document immediately; obtain retrospective consent
• Parental refusal of life-saving treatment: engage senior/ethics committee; parens patriae overrides proxy refusal for life-threatening situations; document everything
• Grief responses: denial, anger, bargaining, depression, acceptance — recognise and respond to stage; empathy before explanation
• Cultural context: identify legal proxies (parents); include them regardless of family spokesperson hierarchy; avoid lay translation of complex diagnoses

REFLECT

Think of a time you witnessed a difficult communication between a clinician and a family — perhaps on a ward round, in an emergency, or at a bedside. What did the clinician do that helped? What, if anything, did they do that made it harder for the family? Now think about yourself in that role — the one who has to say the words. What is your greatest anxiety about breaking bad news, and what skill from the SPIKES framework do you think would be most useful in managing that anxiety? Communication under crisis is a learnable skill. The clinician who has rehearsed this scenario 20 times in simulation will perform it better under real pressure than one who encounters it for the first time when the family is in front of them. When will you begin practising?