Strategy: SPIKES
The plan for delivering bad news to a patient
Setting
Perception
Invitation
Knowledge
Emotions
Strategy and Summary
- Protect the patient’s privacy by choosing a quiet setting where you won't be interrupted.
- Turn off your phone and give your pager to a colleague.
- Ensure you have familiarized yourself with the patient's case.
- Introduce yourself, explaining your role and position in the patient's care team.
Perception
- Establish current state of the patient’s illness (e.g ask them how they have been feeling lately)
- Determine what the patient knows about their illness/what they have been told.
Invitation
- Prepare/warn the patient before disclosing the news.
- Ask whether the patient wants to hear the news, or what level of detail they desire.
- Ask whether the patient would like a family member or friend to be present
Knowledge
- Provide the diagnosis in a straightforward manner.
- Convey the information with brevity and simplicity, and avoid using medical jargon.
- Ask about patient’s end-of-life goals. (e.g is it important for them to travel to their grandson's wedding?)
- Ask about the patient’s goals of care. (e.g possibility of ICU care? being placed on a ventilator?)
- Ask the patient about the need for home support/spiritual support/financial support.
Emotions
- Determine the impact of the news on the patient.
- Allow the patient to express their fears and concerns.
- Use appropriate tone of voice. (e.g empathetic, not rushed)
- Use appropriate body language. (e.g get patient's level, make eye contact, nod when appropriate)
- Respect the patient’s personal space. (e.g touching their arm is okay, touching their face is not)
- Display empathy and provide emotional support to patient.
Strategy and Summary
- Take time to fully answer patient’s questions.
- Ensure the patient understands the information. (e.g ask what they will tell their family about the news)
- Summarize the interview at the end.
References:
Baile, W. F., Buckman, R., Lenzi, R., Glober, G., Beale, E. A., & Kudelka, A. P. (2000). SPIKES—a six-step protocol for delivering bad news: Application to the patient with cancer. The oncologist, 5(4), 302-311.
Toronto Notes. (2019). Case 4 - breaking bad news. Retrieved from torontonotes.ca/osce-stations/psychiatry/case-4-breaking-bad-news/