Breaking Bad News: "Spikes" Protocol
S = "Setting"
P = "Perception"
(i.e. patientís perception of the current situation)
Note different ways of asking; note patientís vocabulary and comprehension; also note denial if present
I = "Invitation"
(Aim to get a clear invitation to the patient to share information)
Different ways of asking (eg "Are you the sort of person who..?), Accept the patientís right not to know.
K = "Knowledge"
NB: ĎAligningí = start at a place compatible with the patientís current comprehension. Use small chunks. Use English not Medspeak. Acknowledge all patientís responses and tailor delivery of information appropriately to patientís responses
E = "Empathising and Exploring"
Acknowledge emotions and their origins Ė patientís and your own - and respond appropriately. Explore, validate and empathise their emotional responses.
S = "Strategy and Summary"
Make a plan via explanation and collaboration. Summarise main areas.
Any questions for now? Contract for next contact.
Rob Buckman Oct 2005