Breaking Bad News

Question 1

What is the model used to break bad news?

Answer 1

SPIKES

S - Setting

P - Perception

I - Invitation

K - Knowledge

E - Empathising & exploring

S - Strategy & summary

Question 2

What needs to be considered in the ‘setting’ part of SPIKES model?

Answer 2

• Make sure you are at least level with the patient
• Use appropriate body language
• Avoid too much eye contact
• Use silences and pauses appropriately
• Use patients own language as a bridge

Question 3

What needs to be considered in the ‘perception’ part of SPIKES model?

Answer 3

What does the patient currently understand of their situation?

Are they clear on why we are having this consultation?

Question 4

What needs to be considered in the ‘Invitation’ part of SPIKES model?

Answer 4

Give a warning shot to the patient that they might be about to hear some bad news

‘We’ve reviewed your results and unfortunately they are causing me some concern”

Question 5

What needs to be considered in the ‘knowledge’ part of SPIKES model?

Answer 5

Make a simple statement that makes it clear what diagnosis you have on your mind

Use small chunks of information to explain to the patient what you have found and what it is you think they have?

Check with the patient that they are understanding what you are telling them

Avoid jargon

Question 6

What needs to be considered in the ‘empathising and exploring emotions’ part of SPIKES model?

Answer 6

Acknowedge the patients emotions

Empathise with the patients emotions

Question 7

What needs to be considered in the ‘strategy and summary’ part of SPIKES model?

Answer 7

Make a plan for next steps

Summarise back to patient

Check if they have any questions