Watch today’s final video in our 3 part video series to learn
1. About SPIKES, a six-step protocol for breaking bad news.
2. How bad news can adversely changes the patients’ view of their future.
3. Why closing the gap between the patient’s expectations and the reality of the patient’s medical condition is paramount.
Click Here – Breaking Bad News Training Videos : Part 1-of-3 – Nurses’ Perspective
Click Here – Breaking Bad News Training Videos : Part 2-of-3 – Patients’ Perspective
Get the full transcript below.
Click Here – Breaking Bad News Training Videos : Part 1-of-3 – Nurses’ Perspective
Click Here – Breaking Bad News Training Videos : Part 2-of-3 – Patients’ Perspective
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Transcript – Consultation Skills Tips
Breaking Bad News Training , Part- 3 of 3, SPIKES Technique.
Let us see about SPIKES, a six-step protocol for breaking bad news.
Hi, thank you for joining me.
I am Hema, a family physician in UK and the founder of csasmartgroup.com where we help General Practice registrars to pass their exams with flying colours.
SPIKES stands for Setting, Perception, Invitation, Knowledge, Empathy/Explore/Emotions, and Strategy/Summary.
It is an alternative to the standard approach, known as CLASS.
Bad news is any news that seriously and adversely changes the patients’ view of their future.
The gap between the patient’s expectations and the reality of the patient’s medical condition is paramount.
You can’t tell how bad the news is unless you have some idea of the patient’s perceptions and expectations of the situation first.
Before you tell patients bad news you must ask them what they know or suspect about the situation so far.
S is for Setting.
Get the physical context right. It covers the C and L parts of the CLASS approach,
ie sitting close to the patient, removing obstructions, keeping eye contact, listening,
remaining silent while the patient is talking, nodding, pausing and repetition, etc.
The first really important detail is to assess the patient’s perception.
P in SPIKES is for patient’s perception.
You have to know how serious the patient thinks the situation is.
Listen to two aspects of the patients’ reply after questioning them about symptoms.
Listen to the level of comprehension and the vocabulary.
This will affect how you handle the interview.
If the level of comprehension is close to the medical facts, less education will be needed at this stage.
If the patient has no idea what the medical facts signify, you have your work cut out.
Use similar vocabulary to the patient.
The pivot of the whole interview is next – the invitation.
Ask the patient what he/she would like to know about the medical situation, if that’s what the patient wants.
The exact phrase isn’t so important, what matters is that you ask.
If the patient says no, which happens rarely, offer to talk to a relative or friend.
Don’t express unwanted information, but make the patient aware it is always on offer.
Then impart information in small chunks, checking the patient knows what you are saying after each snippet.
The K for Knowledge goes simultaneously with the E for Empathy.
As you listen, acknowledge and respond.
As the patient reacts to the news you are giving, so you have to acknowledge and respond to his/her reactions.
At the heart of this is the empathic response.
In CLASS, it’s A for Acknowledgement.
This is the single most important characteristic of breaking news competently.
Without it you’ll appear insensitive.
At the end, agree on the strategy and summarise (SS in CLASS).
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Dr. Hema