SPIKES is the protocol to use when you must deliver bad news. All of the CLASS strategies, plus techniques for dealing with emotional reactions, and giving empathic responses will be brought into play when you must tell patients things they do not want to be true. In this introduction, we'll define what we mean by "bad news", and show you how SPIKES protocol works.
Breaking Bad News-SPIKES overview (9:40)
SPIKES Scenarios: A physician using the SPIKES techniques in patient interactions
Mr. Hawkins - Disclosing a Cancer Diagnosis
Mr. Hawkins, aged 73, has had a prostate biopsy following a screening PSA. The results showed that he has a moderately differentiated adenocarcinoma (Gleeson Score 7). He has not been given much information prior to this interview. In this vignette, the physician will disclose the biopsy results.
Disclosing a cancer diagnosis is a common "breaking bad news" situation. It is often not easy, so it helps to know where to start and how to proceed in giving information and dealing with the patient's responses to the news.
What to watch for
In this interview you will see the physician follow the steps of "SPIKES". Having attended to the setting (S), he asks for the patient's perception of his situation (P), gets an invitation to proceed before disclosing news(I), only then giving the information or knowledge (K). Note that the physician remembers at all times to deal emphatically with any emotion that arises (E), and closes by offering a treatment strategy and summary, or plan, for going forward (S).
Mr. Hawkins - Recurrence
Later in the course of his treatment, Mr. Hawkins experienced back pain and his physician ordered a bone scan. The physician must now advise him that his cancer has metastasized.
Evidence of disease progression is another important "breaking bad news" situation in oncology.
Also in this interaction, the patient appears worried and asks about his prognosis. Again, the patient's perception is somewhat different from the medical facts. It is revealed that his father's cancer experience is a factor in his own reaction: that for him cancer implies a "terrible death". One of the challenges thus becomes being able to provide hope without creating unrealistic expectations.
What to watch for
Again, watch for the physician's use of the SPIKES protocol. Also note the physician's use of the "narrative approach", or a recap of the events so far, and letting the patient tell his version of the medical events. Note also that the physician explores the patient's concern about his prognosis, discovering important information about the patient's fears.
Note the physician's use of plain language (spread versus metastasis), and that he uses techniques such as acknowledgement and supportive alignment, that is, when the physician uses the term "we" or "you and I", he is aligning emphatically with the patient.
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