Buckman’s 6-step guide: S.P.I.K.E.S.
Setting (and listening Skills):
- Privacy
- Involve significant others (1 spokesperson)
- Sit down
- Look attentive and calm – adopt the neutral posture of a psychotherapist
- Listening Mode – silence and repetition
- Availability
Patient’s Perception: “Before you tell, ask.”
Watch for denial and, if so, tread cautiously. Denial is an unconscious mechanism that may facilitate coping and should be treated gently over several interviews.
Invitation: invite patient to share information
Obtaining overt permission respects the patient’s right to know (or not to know).
Knowledge transmission:
Before you break bad news, give your patient a warning that bad news is coming. This gives you the chance to ease into the topic and gives the patient a few seconds longer to prepare psychologically for what may be coming.
As emotions and reactions arise during this discussion, acknowledge them and respond to them:
- use the same language your patient uses — i.e. avoid technical, scientific language
- give the information in small bites and clarify that the patient understands what you have said as the end of each parcel of information
- tailor the rate at which you provide information to your patient
Explore Emotions and Empathise:
the empathic response + exploratory response >> validating feelings.
Summarise and Strategise
References
Adapted from: Buckman, R., M.D., Breaking Bad News: A Six-Step Protocol. How to Break Bad News: A guide for Health Care Professionals. John Hopkins, 1992.
