Breaking Bad News - SPIKES Flashcards
What does SPIKES stand for?
Setting Patient's perception Invitation Knowledge Emotional response Strategy
What does “Setting” entail?
Finding a quiet, private setting that the patient feels comfortable and safe in.
Ensure that you are speaking at the same level as the patient.
Offer the patient the opportunity to have a support person present.
What does “Patient’s perception” entail?
Ask the patient what their understanding of the need for the procedure is.
“Can you tell me what has happened so far?”
“What do they understand about what has happened or led them to this moment.”
What does “Invitation” entail?
Gauge how much information the patient wishes to learn. Gauge whether the patient is ready to receive the news.
“I have you test results, are you happy for me to deliver these to you right now?”
“I was involved in the care of your loved one, are you alright with me discussing this with you?”
What does “Knowledge” entail?
Deliver warning shot
“.Unfortunately thing were a little complicated”
“Unfortunately the test result has come back with something serious”
“I’m afraid that the results were not what we hoped for”
“I’m afraid the procedure did not go as we’d hoped for”
Give time for the patient to react and invite you to continue.
Deliver the news in a short and objective way. Avoid jargon.
“The scan showed a mass, which may represent a tumour”
“During the operation, the surgeons found that the organs were stuck down to each other, unfortunately this meant that a part of the bowel was cut while separating the layers”
*Give space for the patient to process what is being said and immediate response”
Apologise and reflect their emotion
“I’m sorry that this has happened to you. I can understand that this is quite distressing to you”
Provide further knowledge as the patient asks
Strategy
Come up with an action plan for how to manage the issue:
“I would like to come up with an action plan for how we can deal with this together”
- Further investigations and treatment
- Make a time to follow up with the patient again
- Ask them whether you can call a support person to be with them for the next few hours while they are feeling vulnerable.
