How To Break Bad News (Remember SPIKES)

breakingbad-newsan-essential-skill-to-be-acquired-by-every-gynaecologist-dr-dr-sharda-jain-1-638S = Set up for the interview

  • Prepare yourself: familiarize with the patients background, medical info and anticipate some likely questions
  • Environment: arrange for privacy, minimize interruptions and time-constraints
  • Establish a connection with the patient/relatives; Involve patients/relatives family, nurses etc. Ensure you are talking to the right patient/relatives

 P = Assessing the patients Perceptions

  • How much do they know? What happened earlier/prior to hospital arrival?
  • Correct any errors or gaps in patient’s knowledge

I = Obtaining the patients/relatives Invitation

  • How much does the patient/relative want to know?
  • Little detail/too much detail?

K = Giving Knowledge and information to the patient/relatives

  • Start with a warning shot e.g. I’m afraid to inform you or I’m sorry to inform you…
  • Clear and simple information, e.g. Mr. X is dead, BUT avoid excessive bluntness e.g. You are going to die from your cancer
  • Avoid medical jargon e.g. CPR, Defibrillation, Gone to a better place
  • Check understanding

E = Addressing the patients/relatives Emotions

  • Give time to express feelings
  • Observe and acknowledge emotions
  • Show empathy
  • Encourage questions and allow time

S = Strategy and Summary

  • Clear plans of what next
  • Offer follow-up support
Emergency Medicine Kenya Foundation