SPIKES Steps for Breaking Bad News

Physicians can deliver upsetting medical news in a way that is both informative and understanding if they follow five simple steps. Walter F. Baile, MD, chief of psychiatry at the University of Texas, M.D. Anderson Cancer Center in Houston and Robert Buckman, MD, PhD, a medical oncologist and professor at the University of Toronto, developed a protocol with the acronym SPIKES to help physicians remember the steps:

Setting

Create an appropriate setting that provides for: privacy, patient comfort, uninterrupted time, and sitting at eye level; invite a significant other if desired. (All those factors assist in establishing patient rapport.)

Perception

Elicit the patient’s perception of his or her problem. "Tell me what you understand about the reason we did the tests."

Invitation

Obtain the patient’s invitation to disclose the details of the medical condition. "When the test results are completed, are you the type of person who likes to know everything . . ."

Knowledge

Provide knowledge and information to the patient. Give information in small chunks, check for understanding frequently, and avoid medical jargon.

Empathize

Empathize and explore emotions expressed by the patient. For example, say to the crying patient, "I can see that you weren’t expecting this kind of news."

Summary and Strategy

Provide a summary of what you said and negotiate a strategy for treatment or follow-up.