Breaking Bad News

Every day bad news has to be discussed in an Oncology ward or clinic.

1. What are some of the key ways this can be done sensitively?

Ensuring you have time, without a bleep, in a quiet room. The patient should have a family member or friend present, and ideally also a nurse with whom the patient can re-visit the conversation. Ensure that you are in full command of the facts and plan of management. These are key starting points in my book.

Use of clear language, without metaphors or technical jargon, is the next step.

2. Have you heard of SPIKES? What is it?

The 6 steps of SPIKES are explained in this excellent paper. In summary they provide a framework for delivering bad news and are:

S setting up – quiet calm environment, having all facts to hand, ideally with a nurse to support patient.

P perception – need to assess the individual’s perception of the situation, before leaping in with your own perceptions.

I invitation – being sure the individual wants to know / how much they want to know. Compartmentalising facts and limiting them are valid coping mechanisms.

K knowledge – giving this to the patient, in language which is tactful and understandable.

E emotions – addressing these with empathy.

S strategy and summary – moving on to what is going to be done and summarising the discussion

3. How would you go about this difficult task?

Well, only you can tell me that.

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