9. Bad News (14%)

Question 1

Describe SPIKES method to announce bad or serious news

Answer 1

• S—SETTING UP the Interview
• P—Assessing the Patient’s PERCEPTION
• I—Obtaining the Patient’s INVITATION
• K—Giving KNOWLEDGE and Information to the Patient
• E—Addressing the Patient’s EMOTIONS with Empathic Responses
• S—STRATEGY and SUMMARY

Question 2

Describe this step : S—SETTING UP the Interview

Answer 2

• Gather information, test results, treatment options (consider speaking to patient’s other doctors).
• Identify if patient has decisional capacity, and if surrogate decision maker has been identified
• Translator if needed.
• Arrange for some privacy.
• Involve significant others (obtain patient consent).
• Sit down, make connection with the patient (eye contact or touch).
• Manage time constraints and interruptions.

Question 3

Describe this step : PERCEPTION

Answer 3

• What have you been told about your medical situation so far?
• What is your understanding of the reasons we did the TEST?

Question 4

Describe this step : INVITATION

Answer 4

• How would you like me to give the information about the test results?
• Would you like me to tell you the details of the diagnosis?
• Would you like me to give you all the information or sketch out the results and spend more time discussing the treatment plan?

Question 5

Describe this step : KNOWLEDGE

Answer 5

• Warning Shot : I’m afraid I have some bad news, I wish things were different, I wish I could say that, I’m sorry to tell you that…
• Give information in small chunks, check understanding, use nontechnical words
• Generally would like to cover Diagnosis, Treatment Plan, Prognosis and Support

Question 6

Describe this step : EMOTIONS

Answer 6

• Observe for any emotion on the part of the patient. Allow silence, do not argue.
• Identify the emotion experienced by the patient by naming it to oneself. If unclear, open questions to query the patient as to what they are thinking or feeling.
• Identify the reason for the emotion if not clear. After you have given the patient a brief period of time to express his or her feelings, let the patient know that you have connected the emotion with the reason for the emotion by making a connecting statement. = I know that this isn’t what you wanted to hear. I wish the news were better.

Question 7

Describe this step : STRATEGY and SUMMARY

Answer 7

• Identify other sources of support for the patient and incorporate them
• Invite questions
• Learn about patient/family goals given new reality = Knowing that time is short, what’s most important to you?
• Tell them what happens next, make recommendation to the patient/family about the most appropriate medical plan
• There’s so much more we can do to improve your qality of life
• Suggest it may be in the best interest to have “their last moments of life in dignity and peace - a natural peaceful death”, not to prolong the dying experience with procedures that have little benefit
• Arrange definitive follow-up opportunities to assess impact and understanding