Breaking Bad News Flashcards
What model can be used to help facilitate breaking bad news?
SPIKES
How should you start a consultation in which you would be breaking bad news?
- Introduction
- Identity check
- Consent
How can active listening skills be displayed in a consultation?
- Appropriate eye contact
- Open body language
- Nodding
- Avoid interrupting
What is the first ‘S’ in SPIKES?
Setting
What is the ideal setting for breaking bad news?
A comfortable, quiet and private room
Where should breaking bad news never be done?
Standing in a corridor
What are the bare minimum essentials for breaking bad news?
- Everyone sitting
- Some privacy
- Tissues
- No interruptions
- Essential information
Who else may be in the room when breaking bad news?
- Other HCP
- Relatives
- No one
Who decides who else may be in the room when breaking bad news?
The patient
What does the ‘P’ stand for in SPIKES?
Perception
What does ‘perception’ involve in breaking bad news?
- Establishing preceding events
- Establish patient’s knowledge
What does ‘I’ stand for in the SPIKES model?
Invitation
What does ‘invitation’ imply when breaking bad news?
Check that the patient wants to receive the news today
What does the ‘K’ in SPIKES stand for?
Knowledge
What does ‘knowledge’ mean when breaking bad news?
Delivering the information in sizeable chunks and checking regularly for understanding
What should be given before imparting the information on the patient when breaking bad news?
Give a warning shot
What is an appropriate warning shot when breaking bad news?
‘Unfortunately the results were not what we were hoping for…’
What sort of language should be used when breaking bad news?
Simple language
After giving the diagnosis, when should you continue speaking?
Usually after the patient speaks, or when you feel enough time has passed that they are able to process more information
What should you do if a patient has a strong emotional reaction to the news?
Allow them time and space to do so offering tissues where appropriate
What does ‘E’ stand for in SPIKES?
Empathy and emotions
What does ‘empathy and emotions’ involve when breaking bad news?
Empathise with their emotions, acknowledge their feelings and be honest with any information given following the bad news
What does ‘S’ stand for in SPIKES?
Strategy and summary
What does ‘strategy and summary’ involve when breaking bad news?
Making plans for the future and summarising the consultation to check patient understanding
What should a future strategy involve when breaking bad news?
- Plans for follow-up
- Plans for further investigations
- Plans for management
Do all future strategies have to be planned on the day?
No, allow patients time if they need it to process the information
How should breaking bad news be summarised?
- Check understanding
- Repeat any information necessary
- Answer any concerns
- Offer assistance and written information to answer future questions
