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Giving Bad News

Is

an important communication skill


Is a complex communication task which
includes: responding to patients emotional reactions
Involving the patient in decision making
Dealing with the stress created
Involvement of multiple family members
How to give hope when situation is bleak

Giving Bad News


It
It

is a difficult task because:-

is frequent and stressful


Most patients want to know the truth
We are required to tell them what they desire
The truth is unpleasant and will upset them
We are anxious and fear negative evaluation

Giving Bad News


We

feel a burden of responsibility for the


news
The recipient is already distressed
We dont want to make things worse
We want to be honest but not destroy
hope
We are therefore reluctant to deliver bad
news

Giving Bad News


The
Using

Good News!

a plan for determining the patients


values, their wishes for participation in
decision making, and a strategy for
addressing their distress when the bad
news is disclosed can increase our
confidence in the task.

Giving Bad News


The
It

Good News (continued)

may also encourage patients to


participate in difficult treatment decisions
Those who do so have a better quality of
life
Clinicians who are comfortable with giving
bad news are subject to less stress and
burnout.

Giving Bad News


What

do we want to achieve?

To gather

information from the patient


To provide intelligible information in
accordance with their needs and desires
To support them to reduce the emotional
impact and isolation experienced
To develop a plan for management with
the input and cooperation of the patient

The SPIKES Protocol


SETTING

UP the interview
Assessing patients PERCEPTION
Obtaining the patients INVITATION
Giving KNOWLEDGE and information
Addressing the patients EMOTIONS
STRATEGY and SUMMARY

SPIKES
Step

1: S - SETTING UP the interview


Preparation Preparation Preparation
Plan, Privacy, Significant others
Sitting, Non Verbal Behaviour
Time

SPIKES
Step

2: P - Assessing
THE PATIENTS PERCEPTION
Gather before you Give
Patients knowledge, expectations and hopes
What do they understand about the situation?
Unrealistic expectations?
What is their state of mind?
Hopes?
Opportunity to correct misinformation and tailor
your information

SPIKES
Step

3: I Obtaining
the patients INVITATION
Gather before you give
How much does the patient want to know?
Coping

Answer

another

strategy?

questions, offer to speak to

SPIKES
Step

4: K Giving KNOWLEDGE and


information to the patient

Warning shot
Use simple language, no jargon,
Vocabulary and comprehension of patient
Small chunks, avoid detail unless requested
Pause, allow information to sink in
Wait for response before continuing
Check understanding
Check impact

SPIKES
Step

5: E Addressing the patients


EMOTIONS with empathic responses
Shock, isolation, grief
Silence, disbelief, crying, denial, anger
Observe patients responses and identify
emotions
Offer empathic responses

What is Empathy?
The

capacity to recognise emotions that


are being felt by another person.

Empathic Responses
An

indication to the patient that you


recognise what they are feeling (and why)
Verbal and Non verbal
Often associated with the impact of the
news rather than the understanding.
I see that. I appreciate ..
Wait for response
Clarify

SPIKES
Step

6: S STRATEGY and SUMMARY


Are they ready?
Involve the patient in the decision making
Check understanding
Clarify

patients goals

Summarise
Contract

for future

References
SPIKES

A Six-Step Protocol for


Delivering Bad News: Application to the
Patient with Cancer.
WF Baile, R Buckman et al.
The Oncologist 2000;5:302-311