Giving Bad News

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 don’t 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 patient’s 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 patient’s PERCEPTION • Obtaining the patient’s INVITATION • Giving KNOWLEDGE and information • Addressing the patient’s 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 PATIENT’S PERCEPTION • Gather before you Give • Patient’s 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 patient’s 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 patient’s EMOTIONS with empathic responses • Shock, isolation, grief • Silence, disbelief, crying, denial, anger • Observe patient’s 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 patient’s 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