Breaking Bad News: "Spikes" Protocol

S = "Setting"

  1. Physical Ė position of body (level with patient, lower if the patient is angry), body language and eye contact (avoid when situation is "hot")
  2. Listening Skills Ė use of silence and pauses, use of patientís own language as a bridge; appropriate use of touch.

P = "Perception"

(i.e. patientís perception of the current situation)

Note different ways of asking; note patientís vocabulary and comprehension; also note denial if present

I = "Invitation"

(Aim to get a clear invitation to the patient to share information)

Different ways of asking (eg "Are you the sort of person who..?), Accept the patientís right not to know.

K = "Knowledge"

(imparting information)

NB: ĎAligningí = start at a place compatible with the patientís current comprehension. Use small chunks. Use English not Medspeak. Acknowledge all patientís responses and tailor delivery of information appropriately to patientís responses

E = "Empathising and Exploring"

Acknowledge emotions and their origins Ė patientís and your own - and respond appropriately. Explore, validate and empathise their emotional responses.

S = "Strategy and Summary"

Make a plan via explanation and collaboration. Summarise main areas.

Any questions for now? Contract for next contact.


Rob Buckman Oct 2005