SPIKES Protocol – A Framework To Communicate Bad News

doctor using SPIKES protocol to deliver bad news to mother and daughterThe SPIKES protocol for delivering bad news is designed to provide the individual with the most accurate and up-to-date information, respectfully and sensitively. The aim is to ensure that patients receive information that allows them to make informed decisions about their healthcare while maintaining their privacy.

It was developed in response to the growing concern over how bad news is delivered to patients. Too often, medical professionals rush through too much information without considering the individual’s feelings or needs, which can lead to difficult discussions, confusion, sadness, and distress. The goal is to provide a more sensitive and respectful approach that considers the patient’s emotional state and need for accurate medical information.

What Is Considered Bad News?

Bad news can be challenging to hear, especially if it is unexpected. When bad news comes, it can make the patient feel anxious and scared. It is essential that a clinician be sensitive to how the patient feels and communicate what has happened to know as much as possible about their condition.

Some patients prefer to hear bad news in short, blunt sentences. Others may need more time to process the information. Regardless of how the patient responds, making eye contact and being honest about what has happened is essential.

The type of information that is bad news for a patient depends on their situation. However, some examples of potentially bad news include updates on a patient’s health condition or prognosis, hearing that a loved one has passed away, and learning about an emergency that affects them.

When delivering bad news, it is crucial to be mindful of the patient’s emotional state. It is also essential to be clear about what has happened and why it matters. By doing both, healthcare providers can establish rapport and help patients process this difficult information healthily.

The SPIKES Protocol

The SPIKES Protocol for delivering bad news to a patient is designed to ensure that the patient is as prepared as possible for the news and that they can process it appropriately. The protocol includes providing information about the condition, its cause, and potential solutions, discussing any prognosis or outcomes, and providing needed support and resources.

The SPIKES Protocol aims to provide patients with accurate information to make informed decisions about their options. By providing a structured approach to delivering bad news, we hope to create a supportive environment where patients can process the information and begin their journey to recovery.

Origins of the SPIKES Protocol

Baile et al. created the SPIKES protocol, a team of specialists in palliative care, neurology, psychiatry, and social work who felt that patients needed specific instructions on receiving bad news or understanding information about their illness or death with dignity and respect. Baile et al consist of Dr. Watler Baile (MD Anderson Cancer Center), Dr. Michael Levy (Fox Chase Cancer Center), and Dr. Robert Buckman (Toronto Sunnybrook Regional Cancer Centre)

Their work on the S.P.I.K.E.S protocol is vital because it provides specific instructions to patients on receiving bad news or understanding information about their illness or death with dignity and respect. The protocol has been well-received by specialists in palliative care, neurology, psychiatry, and social work, who feel it is necessary for patients experiencing these difficult situations.

There are many different interpretations of the acronym.

Situation / Setting

The “S” in S.P.I.K.E.S stands for “Situation Report” or “Setting” The Situation Report is a communication tool to deliver bad news to patients and their families during difficult times, such as when a loved one has been diagnosed with a severe illness or injury or when the patient has passed away.

The Situation Report includes full information about the patient’s condition and progress and any updates on research efforts being conducted to improve the patient’s prognosis.

The Setting in the SPIKES protocol for delivering bad news to a patient is vital because it affects how the family may react to the information and how they will be able to process it emotionally.

Some families may want privacy during this time, while others may prefer to share their feelings with family and friends around them. We must work with each family individually to find out what would be best for them in terms of setting and atmosphere.

Patient

The “P” in S.P.I.K.E.S stands for “Patient.” The patient is the individual receiving news about their health condition or death, and their family members are essential to providing support during these difficult times.

The patient’s representative should be included in any communication with the patient so that they clearly understand what is being said and can provide feedback if needed. It is important to remember that the patient’s privacy and comfort are our top priorities.

Immediate Family

The “I” in S.P.I.K.E.S stands for “Immediate Family.” The Immediate Family is the family member closest to the patient and is essential to providing support during these difficult times.

Including them in any communication with the patient is crucial so they clearly understand what is being said and can provide feedback if needed. It is also important to remember that their privacy and comfort are our top priorities.

doctor speaking with family in medical clinic

Knowledge

The “K” in S.P.I.K.E.S stands for “Knowledge.” The S.P.I.K.E.S protocol aims to ensure that all relevant information about the patient’s health condition or death is delivered clearly and concisely so the Immediate Family can understand what is happening and provide support as needed.

It is important to remember that knowledge is power, and by providing accurate information, we can help make the patient’s experience as stress-free as possible.

Encouragement / Empathy

The “E” in S.P.I.K.E.S stands for “Encouragement” or “Empathy”. The Encouragement protocol is designed to support the Immediate Family during challenging times by providing them with information and resources that can help them cope with the situation effectively.

Empathy for pain is a critical component of the SPIKES protocol. We must understand and respect the strong emotions that our patients are experiencing, both during the delivery of unfavorable information and throughout their entire health journey.

We must be willing to listen attentively and provide compassion in a way that feels comfortable for them. By doing so, we can help them navigate these difficult times with as much dignity and strength as possible.

Support / Strategy / Summary

The final “S” in S.P.I.K.E.S stands for “Support” or “Strategy”, or “Summarize” The goal of support is to provide emotional and practical support to the Immediate Family during difficult times.

Each family will likely respond differently to the same situation, depending on their backgrounds and experiences. We must be prepared for the potential for emotional reactions, both during the delivery of bad news and throughout the entire health journey.

The goal of summarizing is to provide the Immediate Family with a brief overview of the situation and what they can expect. By doing this, we hope to help them better understand what has happened and prepare for future events.

We must be prepared for the potential for emotional reactions, both during the delivery of bad news and throughout their health journey. When delivering bad news, it is essential to remember that each family will respond differently. We must be willing to listen attentively and provide support in a way that feels comfortable for them.

The BREAKS Protocol – The Alternative

Doctor showing patient scan resultsThe BREAKS (Bad News Deliverance and Emotional Support) protocol was developed as an alternative to the SPIKES Protocol to improve the delivery of bad news to patients. The protocol includes a set of steps that healthcare providers should take when delivering bad news, such as creating a communication plan, establishing boundaries with patients, and developing an approach for breaking the news.

Healthcare providers and medical students who follow the BREAKS Protocol can better support their patients during difficult times and help them feel prepared for future challenges.

The BREAKS Protocol can help healthcare providers deliver bad news without experiencing compassion fatigue in an effective way. By following the steps outlined in the protocol, healthcare providers can improve their communication skills to deliver a plan that meets their patients’ needs and establishes boundaries while breaking the news.

BREAKS is designed to support patients during difficult times, such as when a loved one is hospitalized or receives cancer news. SPIKES did not initially include emotional support; instead, it provided resources and guidance on delivering bad news effectively and respectfully to patients in crises, including those with serious health events.

Patients continuing to receive a BioScan regularly is an excellent method of reassurance. It can help identify progress (i.e., “wins”) and potential issues to provide the patient peace of mind. By identifying possible health issues in advance, patients can address any problems before they become more serious.

 

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