SPIKES

Setting

Patient perspective

Invitation

Knowledge

Empathizing and exploring emotions

Strategy and Summary

S – SETTING

v      Plan ahead! WHEN/ WHERE Choose a private setting. Think WHO should be present?

v      Be aware of body language, eye contact, positioning – face the patient, be on the same level (sit or stand)

v      Pause, speak clear and slow,

LISTEN!

P - PATIENT PERSPECTIVE

v      Ask for it every time - different patients react differently to the same news/diagnosis.

v      The same patient may react differently at various times.

v      Use open-ended questions such as: How can I be helpful? What do you need? How do you feel about it? What would you like to know?

I - An INVITATION

v      Invitation from the patient to you; check how much the patient wants to know and/or share with their loved one?

‘I want to know what the docs mean when they anatomize me…

K – KNOWLEDGE

v      Aligning - start with the patient’s current comprehension. What do you know about this condition?

v      Use small chunks of information at a time– check for understanding

v      Use clear simple English not jargon - “you have cancer” instead of: “we found a tumor/growth/abnormal tumor cells”.

v      Tailor delivery of information to the person’s response.

Recall for information estimated at max. 50%!

o        Preference for information, does not mean preference for decision-making

o        Older males are least likely to take an active role

o        Even less active individuals benefit from good communication

o        Too little/ too much info Is associated with a higher risk of anxiety and depression one year after diagnosis

o        Consider timing ? With a family member? Etc.

Patients and doctors’ agreements on Lung Cancer. Quirt et al, 1997.

! Extent of disease – 64%

! Intent of treatment – 72%

! Probability of cure – 36%

E - EMPATHIZING & EXPLORING EMOTIONS

v      Identify emotions (theirs/yours): fear, anger, despair, worry, hopelessness, shock, sadness, etc.

v      Note denial; Several emotions may exist.

v      Allow patient to express feelings. Legitimate this expression

v      You don’t have to feel the emotion yourself

v      You don’t have to agree with the viewpoint

v      Foster HOPE. Be Honest

v      Be Available - Help choose traditional/ non-conventional treatments; discuss news with loved ones; think of comfort measures

v      Describe a range of possibilities instead of a precise prognosis (“some patients do well for a year or two and have a good quality of life” instead of: “you have 3 months to live”)

v      Make a Connection, show you care.

E-V-E key to address Emotions:

Each response could be one of the following:

v      Exploring - Patient feels like you are interested.

“Can you tell me what you are thinking/feeling

right now?”

v      Validating - Patient feels “normal”

“Anyone in your situation would feel that way”

v      Empathic - Patient feels you are “tuned in”. You recognize the emotion in an appreciative manner:

“I can see how upsetting this is for you and I am so sorry.”

S - STRATEGY and SUMMARY

v      Summarize main areas of discussion.

v      Collaborate to make a PLAN. Be clear about what is going to happen next and what your role would be.

v      Explore - “Do you have any questions now?”

v      Plan the next contact – EARLY! (suggest an early next visit for patient/family questions after digesting the news and to go over the information again).

Patients may not disclose  when delivering bad news because:

1. 1. belief that nothing can be done
   2. reluctance to burden the doctor
   3. desire not to be pathetic or ungrateful
   4. concern that it is not legitimate to mention them
   5. doctors’ blocking behavior
   6. worry that their fears of what is wrong with them will be confirmed