behavior

3. 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

5. Giving Bad News
It is a difficult task because:-
 It 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

6. Giving Bad News
We feel a burden of responsibility for the
news
The recipient is already distressed
We don’t want to make things worse
We want to be honest but not destroy
hope
We are therefore reluctant to deliver bad
news

7. The SPIKES Protocol
SETTING UP the interview
Assessing patient’s PERCEPTION
Obtaining the patient’s INVITATION
Giving KNOWLEDGE and information
Addressing the patient’s EMOTIONS
STRATEGY and SUMMARY

8. SPIKES
Step 1: S - SETTING UP the interview
Preparation Preparation Preparation
Plan, Privacy, Significant others
Sitting, Non Verbal Behaviour
Time

9. SPIKES
 Step 2: P - Assessing
THE PATIENT’S PERCEPTION
 Gather before you Give
 Patient’s 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

10. SPIKES
Step 3: I – Obtaining
the patient’s INVITATION
Gather before you give
How much does the patient want to know?
Coping strategy?
Answer questions, offer to speak to
another

11. 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

12. SPIKES
Step 5: E – Addressing the patient’s
EMOTIONS with empathic responses
Shock, isolation, grief
Silence, disbelief, crying, denial, anger
Observe patient’s responses and identify
emotions
Offer empathic responses

13. 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

14. SPIKES
Step 6: S – STRATEGY and SUMMARY
Are they ready?
Involve the patient in the decision making
Check understanding
Clarify patient’s goals
Summarise
Contract for future

15. 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