3. Giving Bad News Is an important communication skill Is a complex communication task which includes:- responding to patients emotional reactions Involving the patient in decision making Dealing with the stress created Involvement of multiple family members How to give hope when situation is bleak

5. Giving Bad News It is a difficult task because:- It is frequent and stressful Most patients want to know the truth We are required to tell them what they desire The truth is unpleasant and will upset them We are anxious and fear negative evaluation

6. Giving Bad News We feel a burden of responsibility for the news The recipient is already distressed We dont want to make things worse We want to be honest but not destroy hope We are therefore reluctant to deliver bad news

7. Giving Bad News The Good News! Using a plan for determining the patients values, their wishes for participation in decision making, and a strategy for addressing their distress when the bad news is disclosed can increase our confidence in the task.

8. Giving Bad News The Good News (continued) It may also encourage patients to participate in difficult treatment decisions Those who do so have a better quality of life Clinicians who are comfortable with giving bad news are subject to less stress and burnout.

9. Giving Bad News What do we want to achieve? To gather information from the patient To provide intelligible information in accordance with their needs and desires To support them to reduce the emotional impact and isolation experienced To develop a plan for management with the input and cooperation of the patient

10. The SPIKES Protocol SETTING UP the interview Assessing patients PERCEPTION Obtaining the patients INVITATION Giving KNOWLEDGE and information Addressing the patients EMOTIONS STRATEGY and SUMMARY

11. SPIKES Step 1: S - SETTING UP the interview Preparation Preparation Preparation Plan, Privacy, Significant others Sitting, Non Verbal Behaviour Time

12. SPIKES Step 2: P - Assessing THE PATIENTS PERCEPTION Gather before you Give Patients knowledge, expectations and hopes What do they understand about the situation? Unrealistic expectations? What is their state of mind? Hopes? Opportunity to correct misinformation and tailor your information

13. SPIKES Step 3: I – Obtaining the patients INVITATION Gather before you give How much does the patient want to know? Coping strategy? Answer questions, offer to speak to another

14. SPIKES Step 4: K – Giving KNOWLEDGE and information to the patient Warning shot Use simple language, no jargon, Vocabulary and comprehension of patient Small chunks, avoid detail unless requested Pause, allow information to sink in Wait for response before continuing Check understanding Check impact

15. SPIKES Step 5: E – Addressing the patients EMOTIONS with empathic responses Shock, isolation, grief Silence, disbelief, crying, denial, anger Observe patients responses and identify emotions Offer empathic responses

16. What is Empathy? The capacity to recognise emotions that are being felt by another person.

18. Empathic Responses An indication to the patient that you recognise what they are feeling (and why) Verbal and Non verbal Often associated with the impact of the news rather than the understanding. I see that…. I appreciate ….. Wait for response Clarify

19. SPIKES Step 6: S – STRATEGY and SUMMARY Are they ready? Involve the patient in the decision making Check understanding Clarify patients goals Summarise Contract for future

20. References SPIKES – A Six-Step Protocol for Delivering Bad News: Application to the Patient with Cancer. WF Baile, R Buckman et al. The Oncologist 2000;5:302-311