Giving bad news is an important aspect of family medicine. It is defined as information which adversely affects an individual's view of his or her future. It is vital that the setting in which bad news is given is appropriate, and confidential. It is important for the physician to be empathetic, provide knowledge, provide support and ensure follow-up.
SPIKES[]
- S- Setting up the interview
- Arrange for privacy. Safe/neutral environment
- Involve significant others with patient's consent
- Ensure confidentiality
- Sit down and manage time constraints
- Turn off pagers/cellphones
- Review patient's information/chart/literature. Mentally rehearse.
- Introduce yourself
- P - Assess patient's perception
- Use open ended questions to assess patient's understanding on medical conditions and progress to date
- I - Obtain patient's invitation
- Ask how they would like the information provided. ?Details or big picture?
- K- Knowledge to patient
- Warn the patient bad news is coming " Unfortunately I have some bad news to tell you"
- Provide medical facts. Start at level of vocabulary and comprehension of patient
- Use non-technical terms
- Avoid excessive bluntness
- Give information in small amounts and check periodically for understanding
- E - Address patients emotions with empathetic statements
- Observe the emotion and identify it
- Make empathetic statement connecting that emotion
- S- Strategy and Summary
- Ensure appropriate follow-up
- Involve other family members at patient's wishes
- Consider involving interdisciplinary team + community supports
- Address your own needs (need for debrief)
ABCDE[]
- Advance preparation
- Build a therapeutic environment/relationship
- Communicate well
- Deal with patient and family's reaction
- Encourage and validate emotions
Resources[]
http://www.aafp.org/afp/2001/1215/p1975.html http://theoncologist.alphamedpress.org/content/5/4/302.full