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.

Download full-text


Available from: Andrzej Piotr Kudelka, Jan 08, 2014
  • Source
    • "Given these findings, our first test of the effectiveness of organizational bad news training seems to have been successful, thus clearly extending previous research. We successfully integrated principles of delivering bad news from the context of health care (Baile et al., 2000; Rosenbaum et al., 2004) and principles of organizational justice theory (Colquitt, 2001; Leventhal, 1980 "
    [Show abstract] [Hide abstract]
    ABSTRACT: Although giving bad news at work is a stressful experience, managers are often underprepared for this challenging task. As a solution, we introduce organizational bad news training that integrates (a) principles of delivering bad news from the context of health care (i.e., bad news delivery component), and (b) principles of organizational justice theory (i.e., fairness component). We argue that both the formal and fair delivery of bad news at work can be enhanced with the help of training to mitigate distress both for the messenger and the recipient. We tested the effectiveness of training for the delivery of a layoff as a typical bad news event at work. In two studies, we compared the performance of a training group (receiving both components of training) with that of a control group (Study 1, Study 2) and a basics group (receiving the bad news delivery component only; Study 2) during a simulated dismissal notification meeting. In general, the results supported our hypotheses: Training improved the formal delivery of bad news and predicted indicators of procedural fairness during the conversation in both studies. In Study 2, we also considered layoff victims’ negativity after the layoff and found that training significantly reduced negative responses. This relationship was fully mediated by layoff victims’ fairness perceptions. Despite preparation, however, giving bad news remained a challenging task in both studies. In summary, we recommend that organizations provide managers with organizational bad news training in order to promote professional and fair bad news conversations at work.
    Full-text · Article · Jan 2016 · Journal of Applied Psychology
  • Source
    • "The evaluation of how we actually interact and direct our discussions with our patients and, separately, their family caregivers is present in the literature. (Burkhalter and Bromberg, 2003) However, the issue of caregiver communication does not receive the same degree of attention as the area of breaking bad news (Baile et al, 2000), or training medical students in empathic communication (Bayne, 2011). The introduction of a multidisciplinary intake clinic resulted from a quality improvement activity undertaken in the palliative care service of the authors. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Southern Adelaide Palliative Care Services introduced a nurse-led early introduction to a palliative care clinic in 2011. The clinic offers a thorough psychosocial assessment and the provision of information and an introduction to future care planning. The patients and their caregivers are seen together by the nurse practitioner initially for a physical assessment. They are then seen by a social worker to focus on advanced care planning and assessment of social and emotional factors. After the social work visit, the patient and caregiver are separated, and the patient sees the psychosocial nurse for coping and adjustment to illness and the carer sees the caregiver network facilitator to assess their informal supports to assist in the role of community-based caregiving. The pilot study looks at the nature of communication in the clinic where patient and carer are together and compares that to when they are separated. Methods: A total of 33 patients and their caregivers agreed for their coversations to be tape recorded between May and November of 2013. All tape recordings were transcribed verbatim. Ten patient transcripts (n=40) have been coded for quantitative analysis. The codes identify content and function of speech, cues for information and emotion and whether they are responded to by clinicians. Results: Pilot results reveal that caregivers contribute little in the combined clinics and dominate the conversation in the private clinic. Patients, when seen alone, predominantly express emotion related cues, opposed to cues for information. The clinicians focus on their area of specialty, which results in little duplication in this clinic setting. Conclusion: An earlier evaluation of this clinic found that patients and their caregivers appreciate being separated in the clinic setting to have time and privacy to reveal fears and feelings related to end-of-life care. This current study quantifies the patient and caregiver experience and confirms those earlier findings.
    Full-text · Article · Nov 2015 · International journal of palliative nursing
  • Source
    • "Es bewährt sich, wenn man sich an einer inhaltlichen Abfolge wie an einem Leitfaden, z. B. anhand des SPIKES-Protokolls[2]orientiert. Das Akronym SPIKES umfasst 6 Schritte beim Übermitteln schlechter Nachrichten: @BULLET " setting " (Rahmenbedingungen), @BULLET " perception " (Wahrnehmung), @BULLET " invitation " (Einladung), @BULLET " knowledge " (Wissensstand), @BULLET " emotions " (Gefühlslage), @BULLET " summary " (Zusammenfassung). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Hilfreiche, patientenzentrierte Kommunikation in Onkologie und Palliativmedizin ist nichts für Zartbesaitete: Die enormen Herausforderungen an professionelle Kommunikation, mit denen es Ärzte zu tun haben, Situationen, in denen sie sich rat- und hilflos erleben, in der Zwickmühle, ohne Möglichkeit der Rücksprache mit Kollegen oder Vorgesetzten, werden nicht selten verharmlost oder übersehen. Genauso unterbewertet werden jedoch auch die vielen Beispiele gelungener, hilfreicher Kommunikation, mit denen Ärzte ihren Patienten zur Seite stehen und sie nach Kräften unterstützen.
    Full-text · Article · Nov 2015 · best practice onkologie
Show more

We use cookies to give you the best possible experience on ResearchGate. Read our cookies policy to learn more.