OC 9 - breaking bad news

Question 1

What is the communication protocol used in breaking bad news?

Answer 1

SPIKES

Question 2

What does ‘SPIKES’ stand for?

Answer 2

• SETTING and listening skills
• Patient’s PERCEPTION of condition and seriousness
• INVITATION from the patient to give information
• KNOWLEDGE - give the facts
• EXPLORE Emotions and Empathise as patient responds
• STRATEGY and SUMMARY

Question 3

What 3 things fall under ‘Setting (context)’?

Answer 3

1. physical setting (privacy)
2. positioning of patient, relatives, friends
3. body language and eye contact

Question 4

What 4 things fall under ‘listening skills’?

Answer 4

1. open questioning
2. facilitating
   
   • pausing or silence
   • nodding
   • repetition
3. clarifying
4. handling time and interruptions

Question 5

How should you find out the patient’s ‘perceptions’ of condition and seriousness?

Answer 5

ask patient to what what they know or suspect about their current dental/oral problem

as the patient replies:
- LISTEN to level of understanding and anxiety
- note any MISMATCH between the factual information and the patient’s PERCEPTIONS of it

Question 6

How should you get an ‘invitation’ from patient to give information?

Answer 6

find out from the patient if they want to know the details of the oral or dental conditions and/or the treatment

ACCEPT patient’s right not to know
- but offer to answer any questions as patient wishes later

Question 7

How should you give the patient the ‘knowledge’ of their condition?

Answer 7

1. ALIGNING: use language UNDERSTANDABLE to the patient and start at the level they have finished
2. AVOID jargon
3. GIVE information in SMALL chunks
4. CHECK THE RECEPTION: confirm that the patient understands what you are saying after each small significant chunk
5. RESPOND: to the patient’s reactions as they occur
6. EXPLORE DENIAL (if present) - e.g. ‘it must be very difficult for you to accept this situation’

Question 8

How should you ‘explore’ emotions and empathise as the patient responds to bad news?

Answer 8

THE EMPATHETIC RESPONSE

1. identify the emotion e.g. shock, anger, sadness
2. identify the cause or source of the emotion e.g. unexpected bad news
3. respond in a way that shows that you have made a connection between (1) and (2) e.g. ‘I can see that this wasn’t something you were expecting to hear?’

Question 9

When ‘exploring’ emotions, what should you do if you are not certain what the patient is feeling?

Answer 9

use open and direct questions until you are

Question 10

What do you do during the ‘strategy’ stage of giving bad news?

Answer 10

1. think what the best plan of action is
2. assess patient’s expectations of condition treatment and outcome
3. propose a strategy
4. assess patient’s response
5. agree on a plan

Question 11

What should you do during the ‘summary’ stage of giving bad news?

Answer 11

1. summarise
   ‘any important issues or questions we ought to be discussing?’
2. have a clear plan for the next contact