Model for Breaking Bad

News

SPIKES
SPIKES
 Setting up the interview
 Perception of the patient
 Invitation by the patient
 Knowledge to the patient
 Emotions of the patient
 Strategy and summary
Setting up the interview
 Arrange for privacy
 Involve significant others
 Sit down
 Make connection with the patient
 Manage time constraints or interruptions'
Perception of the patient
 Before you tell, ASK
 Example; “What have you been told
about your condition so far?”
 “What is your understanding about why
we carried out the MRI?”
 Can determine if the person is in denial
 Can also determine expectations,
unrealistic or otherwise
Invitation by the patient
 Most patient’s will express a desire to
receive full information
 Information disclosure should ideally be
assessed when ordering tests
 “How would you like me to give you the
results of the tests when we get them?”
 The patient may chose to involve a
family member of friend
Knowledge to the patient
 Give a warning shot
 “Unfortunately I am afraid the news is not good”
 Start at a level of comprehension for the patient
 Use non technical words such as “spread” rather
than “metastasized”
 Avoid seeming blunt as this may anger the
patient “ Your results show your cancer is
agressive and we cant do anything more”
Emotions of the patient
 Respond to the patients emotion with
empathy
 Often shock, disbelief or anger
 Observe for the emotion
 Acknowledge the emotion
 Identify the reason for the emotion
 Connect with the patient
Emotions of the patient (cont’d)
 Doctor; “I’m sorry to inform you that the scan
shows that you have not responded to the
chemotherapy (pause), unfortunately the cancer
has grown further”
 Patient: “I’ve been afraid of this” (cries)
 Doctor: (moves his chair closer and offers the
patient a tissue, pauses) “I realise this is news
that you did not want to hear, I am sorry” (allows
time for the patient to respond or allows space
for silence while the patient gathers their
thoughts)
Emotions of the patient (cont’d)
 Empathic statements;
• I can see how upsetting this is for you
• I can see this news has come as a shock to
you
• I understand this must be difficult for you
• I can see this news has left you feeling angry
Emotions of the patient
 Exploratory statements
• You said you were afraid of this news, tell me what
you frightens you
• Are you able to share with me the reason you feel
so angry
 Validating responses
• I can understand why that may frighten you
• I think your anger is a very normal response to the
circumstances in which you find yourself
Strategy and summary
 Patients who have a clear plan for the
future are less likely to feel anxious
 Check with the patient if they are ready
to discuss ‘next steps’
 Explore patients agenda (ICE),
• Ideas what may help,
• Concerns what is worrying them,
• Expectations what are their hope’s for the future
Breaking Bad News Training
 This is available from the Macmillan
Specialist Palliative Care Team covering
your clinical area
• Macclesfield (community & acute) Tel 01625
663177
• Central Cheshire (community only) Tel 01606 …..