1. Dr P Henn 31.01.2011

2. Your words remembered for years The SPIKES model Developed by oncologists as a structure to break the news of life limiting disease The most widely used breaking bad news model On Black Board

3. Bad News Does not have to be terminal illness Can be life changing diagnosis Chronic disease Limb amputation Loss of vision hearing May have impact beyond the patient Parents Siblings

4. Similar considerations for adults or children Assess level of understanding Child Adult Learning difficulties Elderly Head injury etc......... Involve parents/ family members A team approach Prepare for the interview

5. Breaking bad news (badly)

6. Breaking Bad news (adults)

7. Being informed of my childs disability – Parental recollections

8. SPIKES Setting up the interview Assessing the patients perception Obtaining the patients invitation Giving knowledge & information Addressing the patients emotions with empathic responses Strategy & summary

9. Setting up the interview Privacy Invite relatives Uninterrupted time Try to make an empathic connection with the patient

10. Assessing the patients perception What has the patient been told? What are the patients goals or expectations? Does the patient want to know? Excessive optimism Avoidance

11. Obtaining the patients invitation How much information does the patient want?

12. Giving knowledge & informationIn small chunksCheck for understandingAvoid medical jargon

13. Addressing the patients emotions with empathic responses EmpathiseExplore patients emotions

14. Strategy & summary Outline treatment options Negotiate care with the patient