Breaking bad news

Question 1

What protocol for breaking bad news?
What is involved in each step

Answer 1

SPIKES protocol

S – Setting
 Arrange for some privacy
 Involve significant others
 Sit down
 Make connection and establish rapport with the patient
 Manage time constraints and interruptions.

P – Perception of condition/seriousness
 Determine what the patient knows about the medical condition or what he suspects.
 Listen to the patient’s level of comprehension
 Accept denial but do not confront at this stage.

I – Invitation from the patient to give information
 Ask patient if s/he wishes to know the details of the medical condition and/or treatment
 Accept patient’s right not to know
 Offer to answer questions later if s/he wishes.

K – Knowledge: giving medical facts
 Use language intelligible to patient
 Consider educational level, socio-cultural background, current emotional state
 Give information in small chunks
 Check whether the patient understood what you said
Respond to the patient’s reactions as they occur
 Give any positive aspects first
e.g.: Cancer has not spread to lymph nodes, highly responsive to therapy, treatment available
locally etc.
 Give facts accurately about treatment options, prognosis, costs etc.

E - Explore emotions and sympathize
 Prepare to give an empathetic response:
1. Identify emotion expressed by the patient (sadness, silence, shock etc.)
2. Identify cause/source of emotion
3. Give the patient time express his or her feelings, then respond in a way that demonstrates you
have recognized connection between 1 and 2.

S – Strategy and summary
 Close the interview
 Ask whether they want to clarify something else
 Offer agenda for the next meeting
eg: I will speak to you again when we have the opinion of cancer specialist.