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: 4.87). 02/2000; 5(4):302-11.
Source: PubMed


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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    • "Nevertheless, healthcare professionals benefit from resources giving them an idea of what other people found helpful in order to develop their own personal style of BSN (Buckman and Kason, 1992). The most commonly cited guideline for breaking bad and significant news is the SPIKES protocol; however the efficacy of SPIKES is not empirically supported and its relevance to care across cultures remains under researched (Baile et al., 2000; Buckman, 2005; Ptacek and Ptacek, 2001; Vandkieft, 2001). There was criticism that guidelines are inexplicit regarding emotional and supportive content, focussing on breaking significant news, rather than receiving significant news (Arber and Gallagher, 2003; Duke and Bailey, 2008). "
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    ABSTRACT: Purpose: The aim of the research was to explore specialist cancer and palliative care nurses experience of delivering significant news to patients with advanced cancer. Method: A qualitative phenomenological research study was conducted to capture nurses' experiences with the aim of understanding how cancer and palliative care clinical nurse specialists work towards disclosure of advanced and terminal cancer. Data were collected through semi-structured interviews with 10 clinical nurse specialists working in one acute NHS trust. Clinical nurse specialists were recruited from the following specialities: lung cancer, breast cancer, gynaecological cancer, upper and lower gastrointestinal cancer and palliative care. Results: Four themes emerged from the data: importance of relationships; perspective taking; ways to break significant news; feeling prepared and putting yourself forward. The findings revealed that highly experienced clinical nurse specialists (CNSs) felt confident in their skills in delivering significant news and they report using patient centred communication to build a trusting relationship so significant news was easier to share with patients. CNSs were aware of guidelines and protocols for breaking significant and bad news but reported that they used guidelines flexibly and it was their years of clinical experience that enabled them to be effective in disclosing significant news. Some areas of disclosure were found to be challenging in particular news of a terminal prognosis to patients who were of a younger age. Conclusion: CNSs have become more directly involved in breaking significant news to those with advanced cancer by putting themselves forward and feeling confident in their skills.
    European journal of oncology nursing: the official journal of European Oncology Nursing Society 10/2015; DOI:10.1016/j.ejon.2015.09.006 · 1.43 Impact Factor
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    • "The aim of this study was to investigate whether the doctor's delivery style accounted for the differences in individual variations in HR and SC response patterns in doctors. Specifically, it was hypothesized that HR and SC response patterns of doctors who utilized a forecasting style would differ from those who utilized a blunt or stalling delivery style, consistent with the recommendations that a staged delivery of bad news be given that includes a 'warning shot' to pre-empt the delivery of the news [24] [25]. The physiological indices (HR and SC) used in this study were chosen as they differ in terms of pattern of response, latency and relationship to central arousal mechanisms of action [26] [27]. "
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    ABSTRACT: The purpose of this study was to investigate the relationship between doctors' bad news delivery style and their experience of physiological stress during simulated bad news consultations. 31 doctors participated in two simulated breaking bad news (BBN) consultations. Delivery style was categorized as either blunt, forecasting or stalling (i.e. avoidant), based on the time to deliver the bad news and qualitative analysis of the interaction content and doctor's language style. Doctors' heart rate (HR) and skin conductance (SC) were recorded in consecutive 30s epochs. Doctors experienced a significant decrease in HR (F(1,36)=44.9, p<.0001) and SC (F(1,48)=5.6, p<.001) between the pre- and post-news delivery phases of the consultation. Between-group comparisons for the three delivery styles did not identify any significant differences in HR (F(2,36)=2.2, p>.05) or SC (F(2,48)=.66, p>.05). Doctors experience heightened stress in the pre-news delivery phase of breaking bad news interactions. Delaying the delivery of bad news exposes doctors to a longer period of increased stress.This suggests that medical students and doctors should be taught to deliver bad news without delay, to help mitigate their response to this stressful encounter. Copyright © 2015. Published by Elsevier Ireland Ltd.
    Patient Education and Counseling 08/2015; 98(10). DOI:10.1016/j.pec.2015.08.023 · 2.20 Impact Factor
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    • "Usually BBN is taught by providing a theoretical framework such as the SPIKES model (Baile et al., 2000) and providing an opportunity for practice through role-play. Table 1 briefly outlines the SPIKES model. "

    04/2015; 15(2):14. DOI:10.14434/josotl.v15i2.13262
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