BREAKING BAD NEWS

Dr P Henn31.01.2011

Your words remembered for years The SPIKES model

Developed by oncologists as a structure to break the news of life limiting disease

The most widely used ‘breaking bad news’ model

On Black Board

Bad News

Does not have to be terminal illness Can be life changing diagnosis

Chronic disease Limb amputation Loss of vision hearing

May have impact beyond the patient Parents Siblings

Similar considerations for adults or children

Assess level of understanding Child Adult

Learning difficulties Elderly Head injury etc.........

Involve parents/ family members A team approach Prepare for the interview

Breaking bad news (badly)

Breaking Bad news (adults)

Being informed of my child’s disability – Parental recollections

SPIKES

Setting up the interview

Assessing the patient’s perception

Obtaining the patient’s invitation

Giving knowledge & information

Addressing the patient’s emotions with empathic responses

Strategy & summary

Setting up the interview

Privacy

Invite relatives

Uninterrupted time

Try to make an empathic connection with the patient

Assessing the patients perception

What has the patient been told?

What are the patients goals or expectations?

Does the patient want to know?Excessive optimism

Avoidance

Obtaining the patients invitation

How much information does the patient want?

Giving knowledge & information

In small chunks

Check for understanding

Avoid medical jargon

Addressing the patient’s emotions with empathic responses

Empathise

Explore patient’s emotions

Strategy & summary

Outline treatment optionsNegotiate care with the patient