SPIKES

Protocol used in clinical medicine to break bad news to patients and families

The SPIKES protocol is a method used in clinical medicine to break bad news to patients and families.[1][2][3][4][5][6][7] As receiving emotionally distressing information can cause distress and anxiety,[7] clinicians need to deliver the news carefully.[8] Using the SPIKES method for introducing and communicating information to patients and their families, can aid in the presentation of the material. The SPIKES method is helpful in providing an organized manner of communication during situations that are typically complex and difficult to communicate. According to research related to the SPIKES method, important factors to consider when using this protocol involve empathy, acknowledgement and validation of feelings, providing information about intervention and treatment, and ensuring that the patient understands the news being delivered.[1]

The protocol was first proposed in 2000 by Baile et al, in the context of oncology.[9][10]

## Steps

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The name SPIKES is an acronym, where the letters stand for:[9][1][8]

* S: setting, i.e. setting up the consultation appropriately:

→ The patient should only be provided with the bad news when they are in a private setting that contains little to no distractions to ensure the message is being properly received. Examples of inappropriate settings are: via phone call or in an open area such as a hallway. Furthermore, the clinician should remember to be facing the patient and the family throughout the process and establish therapeutic alliance or connection through the use of eye contact and physical touch, i.e. holding a hand or touching an arm.

* P: perception, i.e. assessing the patient's perception of the situation:

→ The clinician should initiate the process by asking the patient what they believe is going on. This can allow the clinician to find out to what extent the patient knows about the situation, and also engages the patient, acquiring their attention. It allows for them to realize that their thoughts matter and forms a starting point for how to proceed. Most importantly, the response of the patient can lead to any misconceptions to be corrected by the clinician immediately.[11][12]

* I: invitation, i.e. prompting the patient to invite the clinician to deliver the news:

→ Phrases such as "Shall I share the results of the scan with you now?" or "Is this a good time to share with you what I believe is going on?" allow for the patient to decide if they are ready to proceed and also allow for open discussion to follow. Phrasing is important because the fundamental purpose of this step is for the clinician to request permission to share unpleasant news with the patient. The way this is worded must show respect for the patient's feelings and inquire about their readiness to receive news.[11]

* K: knowledge, i.e. providing the knowledge to the patient:

→ The clinician should speak slowly, maintain eye contact, and use terms both parties can understand. The clinician should then explain what the bad news means for the patient while avoiding adding extra details initially as this is the place to be clear and concise about what is happening.

* E: empathy, i.e. empathizing with the impact of the news on the patient:

→ Understanding the thoughts and feelings in the minds of the patient and their family can be difficult. It is often best for the clinician to remain silent instead of speaking out as everyone is processing emotions. When the clinician feels it is appropriate to speak, they should speak with empathy and acknowledge that the patient is feeling something. Tears or silence should never be discouraged, this may be a processing strategy that is necessary to fully acknowledge the situation. Support should be provided.[11]

* S: strategy, i.e. devising a strategy for what to do next:

→ The clinician then summarizes all thoughts and helps the patient decide where to go from here. Options to discuss may be treatment, setting another meeting, discussing hospice care, etc. Each situation is unique and it is best to do what is in the best interest of the patient's wants and needs.[13]

## References

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1. ^ a b c Kaplan, Marcelle (1 August 2010). "SPIKES: A Framework for Breaking Bad News to Patients With Cancer". Clinical Journal of Oncology Nursing. 14 (4): 514–516\. doi:10.1188/10.CJON.514-516. PMID 20682509.
2. ^ Dean, Antonia; Willis, Susan (2 June 2016). "The use of protocol in breaking bad news: evidence and ethos" (PDF). International Journal of Palliative Nursing. 22 (6): 265–271\. doi:10.12968/ijpn.2016.22.6.265. PMID 27349844.
3. ^ Seifart, C.; Hofmann, M.; Bär, T.; Riera Knorrenschild, J.; Seifart, U.; Rief, W. (2014). "Breaking bad news–what patients want and what they get: evaluating the SPIKES protocol in Germany". Annals of Oncology. 25 (3): 707–711\. doi:10.1093/annonc/mdt582. PMC 4433514. PMID 24504443.
4. ^ de Moura Villela, Edlaine Faria; Bastos, Luana Kronit; de Almeida, Wanderson Sant’ana; Pereira, Andressa Oliveira; de Paula Rocha, Matheus Silva; de Oliveira, Fábio Morato; Bollela, Valdes Roberto (14 February 2020). "Effects on Medical Students of Longitudinal Small-Group Learning about Breaking Bad News". The Permanente Journal. 24 (2). doi:10.7812/TPP/19.157. PMC 7039420. PMID 32097117.
5. ^ Servotte, Jean-Christophe; Bragard, Isabelle; Szyld, Demian; Van Ngoc, Pauline; Scholtes, Béatrice; Van Cauwenberge, Isabelle; Donneau, Anne-Françoise; Dardenne, Nadia; Goosse, Manon; Pilote, Bruno; Guillaume, Michèle; Ghuysen, Alexandre (November 2019). "Efficacy of a Short Role-Play Training on Breaking Bad News in the Emergency Department". Western Journal of Emergency Medicine. 20 (6): 893–902\. doi:10.5811//westjem.2019.8.43441. PMC 6860397. PMID 31738716.
6. ^ Alves, Carolina Guimarães Bonfim; Treister, Nathaniel Simon; Ribeiro, Ana Carolina Prado; Brandão, Thaís Bianca; Tonaki, Juliana Ono; Lopes, Marcio Ajudarte; Rivera, César; Santos-Silva, Alan Roger (November 28, 2019). "Strategies for communicating oral and oropharyngeal cancer diagnosis: why talk about it?". Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 129 (4): 347–356\. doi:10.1016/j.oooo.2019.11.014. PMID 31928903. S2CID 210191704.
7. ^ a b Zheng, Ying; Lei, Fang; Liu, Bao (14 December 2019). "Cancer Diagnosis Disclosure and Quality of Life in Elderly Cancer Patients". Healthcare. 7 (4): 163. doi:10.3390/healthcare7040163. PMC 6956195. PMID 31847309.
8. ^ a b "Ask the Hematologist: SPIKES Protocol For Delivering Bad News to Patients". Hematology.org. July 1, 2017. Archived from the original on March 2, 2020. Retrieved March 2, 2020.
9. ^ a b Baile, Walter F.; Buckman, Robert; Lenzi, Renato; Glober, Gary; Beale, Estela A.; Kudelka, Andrzej P. (August 2000). "SPIKES—A Six‐Step Protocol for Delivering Bad News: Application to the Patient with Cancer". The Oncologist. 5 (4): 302–311\. doi:10.1634/theoncologist.5-4-302. PMID 10964998.
10. ^ "Breaking bad news - The MDU". Themdu.com.
11. ^ a b c "Course : Course: To Err is Human" (PDF). Who.int. Retrieved 27 November 2021.
12. ^ Monden, Kimberley R.; Gentry, Lonnie; Cox, Thomas R. (11 December 2017). "Delivering Bad News to Patients". Baylor University Medical Center Proceedings. 29 (1): 101–102\. doi:10.1080/08998280.2016.11929380. PMC 4677873. PMID 26722188.
13. ^ Mostafavian, Zahra; Shaye, ZahraAbbasi (2018). "Evaluation of physicians' skills in breaking bad news to cancer patients". Journal of Family Medicine and Primary Care. 7 (3): 601–605\. doi:10.4103/jfmpc.jfmpc_25_18. PMC 6069664. PMID 30112317.

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