Setting Perception Invitation Knowledge Empathy Strategies (SPIKES) protocol for breaking bad news

Introduction

Protocol for delivering bad news or discussing poor prognosis.

Procedure

• S: Setting:
  • plan ahead, have appropriate personnel & family members present
  • anticipate & plan for possible patient reactions
• P: Perception
  • ask patient what he/she has been told about the disease & the purpose of the meeting
  • correct any misconceptions
• I: Invitation
  • find out how much the patient wants to know & how he/she would prefer to hear information
• K: Knowledge
  • give the patient the news
  • use short declarative sentences without jargon
  • pause after delivering the news to address emotional response
• E: Empathy
  • use empathetic statements to address emotional response
  • resist temptation to attempt to fix the situation
• S: Strategize
  • emphasize what can be done
  • shift hope to achievable goals

Notes

• improves patient satisfaction
• reduces depression & anxiety

* if language is a barrier, use a professional medical interpreter

More general terms

• protocol

Additional terms

• discussing poor prognosis