Article

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.

0 Bookmarks
 · 
277 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: EinleitungZur ärztlichen Aufgabe gehört unter anderem das Überbringen von schlechten Nachrichten an Patienten und ihre Angehörigen. Schlechte Nachrichten werden definiert als „[Nachricht], welche in einem kognitiven, emotionalen oder sich auf das Verhalten auswirkenden Defizit in der Person, welche die Nachricht erhält, resultiert“. Dieses Defizit hält für einige Zeit an, nachdem die Nachricht überbracht wurde ([13], S. 496). Die Bewertung, ob eine Mitteilung in die Kategorie „schlechte Nachrichten“ gehört, ist für den Patienten subjektiv. Der Arzt kann versuchen, sich in den Patienten hineinzuversetzen, aber die abschließende Beurteilung der Nachricht liegt beim Patienten. Es gibt diverse Studien über die Ansichten von Ärzten über das Überbringen schlechter Nachrichten [2,4,9]. Viele Ärzte haben das Überbringen schlechter Nachrichten im Rahmen ihres Studiums oder ihrer Weiterbildung nicht gelernt [7] und empfänden eine Ausbildung in diesem Gebiet als hilfreich [2]. Die Patienten wünsc ...
    Ethik in der Medizin 09/2012; 24(3):241-244. DOI:10.1007/s00481-011-0177-1 · 0.54 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In a regional hospital, many patients are newly diagnosed with cancer. Breaking the bad news in these patients and their relatives is a tough task. Many doctors are not experienced in talking to patients about death or death-related diseases. In recent years, there have been great efforts to change the current situation. The aim of this study was to investigate the experience and education of medical personnel in breaking bad news in a secondary hospital. 59 doctors from General Hospital of Komotini, Greece were included in the study. All the doctors were in clinical specialties that treated cancer patients. A brief questionnaire was developed based on current guidelines such as Baile/SPIKES framework and the ABCDE mnemonic. Residents are involved in delivering bad news less frequently than specialists. Only 21 doctors (35.59%) had specific training on breaking bad news. 20 doctors (33.90%) were aware of the available techniques and protocols on breaking bad news. 47 doctors (79.66%) had a consistent plan for breaking bad news. 57 (96.61%) delivered bad news in a quiet place, 53 (89.83%) ensured no interruptions and enough time, 53 (89.83%) used simple words and 54 (91.53%) checked for understanding and did not rush through the news. 46 doctors (77.97%) allowed relatives to determine patient's knowledge about the disease. There were low rates of specific training in breaking bad news. However, the selected location, the physician's speech and their plan were according to current guidelines.
    Indian Journal of Palliative Care 01/2015; 21(1):35-8. DOI:10.4103/0973-1075.150172
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Abstract: Medical providers are trained to investigate, diagnose, and treat cancer. Their primary goal is to maximize the chances of curing the patient, with less training provided on palliative care concepts and the unique developmental needs inherent in this population. Early, systematic integration of palliative care into standard oncology practice represents a valuable, imperative approach to improving the overall cancer experience for adolescents and young adults (AYAs). The importance of competent, confident, and compassionate providers for AYAs warrants the development of effective educational strategies for teaching AYA palliative care. Just as palliative care should be integrated early in the disease trajectory of AYA patients, palliative care training should be integrated early in professional development of trainees. As the AYA age spectrum represents sequential transitions through developmental stages, trainees experience changes in their learning needs during their progression through sequential phases of training. This article reviews unique epidemiologic, developmental, and psychosocial factors that make the provision of palliative care especially challenging in AYAs. A conceptual framework is provided for AYA palliative care education. Critical instructional strategies including experiential learning, group didactic opportunity, shared learning among care disciplines, bereaved family members as educators, and online learning are reviewed. Educational issues for provider training are addressed from the perspective of the trainer, trainee, and AYA. Goals and objectives for an AYA palliative care cancer rotation are presented. Guidance is also provided on ways to support an AYA’s quality of life as end of life nears.

Full-text (2 Sources)

Download
62 Downloads
Available from
May 19, 2014