SPIKES-A six-step protocol for delivering bad news: Application to the patient with cancer

The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
The Oncologist (Impact Factor: 4.54). 02/2000; 5(4):302-11.
Source: PubMed

ABSTRACT We describe a protocol for disclosing unfavorable information-"breaking bad news"-to cancer patients about their illness. Straightforward and practical, the protocol meets the requirements defined by published research on this topic. The protocol (SPIKES) consists of six steps. The goal is to enable the clinician to fulfill the four most important objectives of the interview disclosing bad news: gathering information from the patient, transmitting the medical information, providing support to the patient, and eliciting the patient's collaboration in developing a strategy or treatment plan for the future. Oncologists, oncology trainees, and medical students who have been taught the protocol have reported increased confidence in their ability to disclose unfavorable medical information to patients. Directions for continuing assessment of the protocol are suggested.

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Available from: Andrzej Piotr Kudelka, Jan 08, 2014
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    • "The SPIKES protocol was most frequently utilised as a communication tool in the development of questionnaires (Cleary et al., 2010a,b) and training (McNeilly & Wengel, 2001). This is a framework borrowed from oncology where it was developed to synthesise information in a stepwise fashion (see Table 4; Baile et al., 2000) and has been found to be effective, even after extensive clinical research (Cleary et al., 2009). The six SPIKES steps include: Setting up the interview; assessing the individual's Perception of their medical circumstances; obtaining their Invitation to receive the information; giving the requisite Knowledge; responding Empathically to emotions; and Summarizing the treatment processes. "
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    ABSTRACT: Abstract Background: There is limited understanding of the mechanisms used to effectively communicate with service-users about their mental health diagnoses. Aims: To conduct a systematic synthesis of studies that present data on the communication of a psychiatric diagnosis. Methods: Comprehensive database and manual searches were conducted resulting in the inclusion of 30 quantitative and qualitative papers. Results: The majority of studies were descriptive. The rate of service-users being informed of their diagnosis has increased over the past decade. Consumer communication preferences were not always satisfactorily addressed in practice. Individual characteristics of service-users and clinicians influenced whether a diagnostic discussion took place. Results from intervention studies aimed at facilitating diagnostic communication reported significant improvements in service-user satisfaction and mood and clinician communication skills. Conclusions: This review highlights a gap in the system of communication between clinicians and service-users. To assist clinicians to talk effectively with individuals about their mental health, communication protocols and training need to be further developed and assessed. Such developments would benefit from well-designed randomised controlled trial protocols, should incorporate service-users' preferences and address stigma-related concerns.
    Journal of Mental Health 10/2014; 23(5):261-270. DOI:10.3109/09638237.2014.951474 · 1.40 Impact Factor
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    • "Delivering bad news is difficult for physicians; therefore, phrases like ''dropping the bomb'' are often used to describe the daunting task (Baile et al., 2000; Mueller, 2002). Although the undertaking of delivering bad news is challenging, it can be done effectively, creating increased patient satisfaction and decreased patient emotional responses (Mast et al., 2005). "
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    • "As diagnosis can be a challenging time for individuals (Cleary, Hunt, Escott, et al., 2010), their families (Greenwood, Hussain, Burns, & Raphael, 2000) and clinicians (Cleary, Hunt, & Walter, 2010) calls have been made to improve clinician competencies and confidence when initially discussing a diagnosis by providing training (Cleary, Hunt, & Walter, 2010; Gerrity, Cole, Dietrich, & Barrett, 1999; Jha, et al., 2001; Luderer & Bocker, 1993; Milton & Mullan, In press; Scardovi, et al., 2003; Shergill, et al., 1998; Wong, et al., 2007) and developing protocols (Cleary, Hunt, & Horsfall, 2009; Milton & Mullan, In press). To address this need, a step-wise model of breaking news borrowed from oncology has been advocated (SPIKES protocol; See (Baile, et al., 2000; Cleary, Hunt, Escott, et al., 2010) and Table 2), and a model specifically tailored to discussing a schizophrenia diagnosis has been developed (See (Levin, et al., 2011) and Table 2). None of these models have been empirically tested in mental health, nor have they incorporated viewpoints service users. "
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    ABSTRACT: Helpful strategies for communicating news of a serious mental health diagnosis are poorly understood. This study explored service users' preferences for how they would like clinicians to deliver such news when a diagnosis of mental illness is made. Qualitative interviews were conducted with forty-five individuals identifying with serious mental illness in eleven community based mental health facilities. Inductive thematic analysis resulted in eight primary themes. Five themes related to the structure and content of the discussion; including a focus on information exchange, using an individualized collaborative partnership paradigm, addressing stigma, balancing hope with realism, and recognizing the dynamic nature of diagnosis. The remaining themes related to the involvement of others; including the importance of clinicians' communication and relationship skills, involvement and education of carers, and offering an opportunity for peer support. The product of the synthesis of themes is a step-wise model for communicating news of mental health diagnosis.
    Community Mental Health Journal 07/2014; 51(4). DOI:10.1007/s10597-014-9761-4 · 1.03 Impact Factor
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