Breaking Bad News
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Transcript Breaking Bad News
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 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
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
Giving Bad News
The Good News!
Using a plan for determining the patient’s
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 Good News (continued)
It 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 patient’s PERCEPTION
Obtaining the patient’s INVITATION
Giving KNOWLEDGE and information
Addressing the patient’s 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 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
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
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 patient’s
EMOTIONS with empathic responses
Shock, isolation, grief
Silence, disbelief, crying, denial, anger
Observe patient’s 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 patient’s 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