Using SPIKES: Six steps to breaking bad news to patients

In your practice, do you use SPIKES?

Breaking bad news is a complex skill as, in addition to the verbal component, it also requires the ability to recognise and respond to the patient’s emotions, dealing with the stress that the bad news creates and yet still being able to involve the patient in any decisions and maintaining hope where there may be little. There is also the likelihood that it will be a triadic consultation with relatives present. SPIKES is a six-step protocol which has been shown to improve the confidence of clinicians who use it when breaking bad news to cancer patients:[1] :

Setting up the interview.
Assessing the patient’s Perception.
Obtaining the patient’s Invitation, as shunning information is a valid psychological coping mechanism.
Giving Knowledge and information to the patient.
Addressing the patient’s Emotions with Empathetic response.
Having a Strategy and Summarising.




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