Difficult Conversation

Question 1

Outline the SPIKES mnemonic for breaking bad news

Answer 1

Setting
Perception
Invitation
Knowledge
Empathy
Strategy and Summary

Question 2

Outline the SETTING part of the SPIKES mnemonic

Answer 2

Ensure it is in a private place and sitting down!

‘I was hoping to have a conversation with you, are you okay to have that discussion right now? is it alright if we do it here? Would you like a family member or friend with you?’

Question 2

Outline the PERCEPTION part of the SPIKES mnemonic

Answer 2

Discuss the sequence of events up to this point

What do you know already about what’s been happening?

Give a warning shot:
“Symptoms like the ones you’ve been describing can sometimes be as a result of … , but sometimes they can be as a result of more serious underlying conditions”

Question 3

Outline the INVITATION part of the SPIKES mnemonic

Answer 3

Check if the patient wants to receive their results today – “I have the result here today, would you like me to explain it to you now?”.

Question 4

Outline the KNOWLEDGE part of the SPIKES mnemonic

Answer 4

Use a warning shot to indicate that you have bad news: “As you know we took a biopsy/did a scan, and unfortunately the results were not as we hoped”.

Pause so the patient can digest the information

Provide the diagnosis using simple language: “I’m sorry to tell you this, but the results from the investigations show you have cancer”.

Question 5

Outline the EMPATHY part of the SPIKES mnemonic

Answer 5

Give the patient time to take everything in

‘I can see that this is not the news that you expected, I’m so sorry’

‘I know this is a lot to take in, I am here to support you through this and answer any questions you might have’

Question 6

What can you say if a patient asks you a question that you can’t answer e.g. about their prognosis?

Answer 6

“I’m so sorry, but at this stage, I don’t have enough information to answer that. Hopefully in the next few weeks once we’ve completed other tests I can be clearer. Sorry, I can appreciate that it’s frustrating to be left with unanswered questions’

Question 7

Outline the STRATEGY AND SUMMARY part of the SPIKES mnemonic

Answer 7

Inform them of the follow-up arrangements:
‘I am going to refer you to…. ‘
or
‘ I will see you back in clinic so that we can have another conversation once you’ve had some time to process’

Check the patient’s understanding of the bad news you have delivered - ‘ I appreciate once you’ve heard news like this it can be hard to take in what someone is saying - is there anything you didn’t quite understand or would like me to clarify? ‘

‘If you would like me to help you to tell family or friends about this news I am happy to help’

‘If you have any more questions when you’re home you can talk to our clinical nurse specialists’

‘You can find out more information online at…’