10.1 Breaking Bad News

Question 1

Give 3 examples when bad news must be given

Answer 1

If terminally ill
If diagnosed with a debilitating condition
Around miscarriage

Question 2

Why may some patients not see bad news as a bad thing?

Answer 2

Got a diagnosis
Can be treated
Less pain
Not a burden on carers

Question 3

Give 3 reasons for varying the amount of bad news given

Answer 3

The patient's wishes
The patient's understanding of their condition
The nature of the condition
The complexity of treatment
The risk of the treatment

Question 4

Why is it important to tell patients bad news?

Answer 4

To maintain a good relationship
To reduce uncertainty
To prevent unrealistic expectations
To allow adjustment
To promote open communication

Question 5

Why is it difficult to break bad news?

Answer 5

Empathy for patient
Feel like you have failed as a doctor
Want to protect patient
May be unsure of their reaction
Can be time-consuming

Question 6

What may happen if bad news is given poorly?

Answer 6

Damage patient-doctor relationship

Patient may become distressed

Question 7

What does the acronym SPIKES stand for?

Answer 7

Setting and listening skills
Patient perspective
Information
Knowledge
Empathy
Summary and strategy

Question 8

In breaking bad news, what comes under the ‘setting’ heading of SPIKES?

Answer 8

Breaking news face-to-face
Ensure privacy
Ensure there is enough time
Find out who the patient wants present
Eye contact
Introduce yourself
Listen well

Question 9

In breaking bad news, what comes under the ‘patient’s perception’ heading of SPIKES?

Answer 9

What does the patient know already?

Question 10

In breaking bad news, what comes under the ‘information’ heading of SPIKES?

Answer 10

Don’t assume the patient want to know everything, respect decline of information, allow for denial of information

Question 11

In breaking bad news, what comes under the ‘knowledge’ heading of SPIKES?

Answer 11

give information in small chunks, start gently, warn them bad news is coming, check understanding, do not use jargon, explain clearly

Question 12

In breaking bad news, what comes under the ‘empathy’ heading of SPIKES?

Answer 12

Respond to patient’s emotions, validate emotions, listen to concerns

Question 13

In breaking bad news, what comes under the ‘summary and strategy’ heading of SPIKES?

Answer 13

Summarise conversation, check understanding, agree on next step of treatment, give opportunity to ask questions, ask if they want anyone to be contacted

Question 14

What is the definition of bad news?

Answer 14

Information that drastically alters a patient’s view of the future for the worst