Because many conversations between healthcare professionals and patients discuss serious issues concerning patient’s health, it is extremely important to make sure that the practitioner uses appropriate communication skills. These discussions should always be kind and informative. You should maintain eye contact, deliver the information with respect and care and be open to the other’s point of view.
Having a difficult conversation with a patient or family is extremely stressful no matter how good your communication skills are! When delivering serious information, or information that is going to significantly change the patient’s view of his or her life, the way that the news is delivered is monumental. It can make the difference between the patient feeling hopeless and alone or feeling that there is a team of healthcare professionals that will work with them throughout their journey.
In today’s healthcare environment, doctors, nurses and managers are involved in delivering different kinds of sensitive information to various types of patients. Many guidelines have been developed to direct these discussions so that both you and the patient feel listened to and respected. One such guideline is the SPIKES protocol. It is an easy to follow approach when serious news is to be delivered.
The SPIKES Protocol
SETTING UP- Prior to meeting with the patient, discuss the situation with other care team members to make sure that you are presenting a unified message. Practice what you are going to say. Ask the patient if there are any family members they want to include in the meeting. Find a quiet undisturbed place to meet and turn off your phone/pager.
PERCEPTION – Ask what the patient already knows about the situation; for example, what the results of the test mean. This will allow you to determine how you are going to approach the subject. If the patient perceives that you are not empathetic towards them in your delivery, they may not be open to what you have to say.
INVITATION – Ask for permission to share some new information. This shows respect for them and their needs. For example, they may want you to wait until their family is present.
KNOWLEDGE – Warn the patient that the news is not good. Saying things like: “Unfortunately, I have some bad news to share” or “Things are not going in the direction we had hoped” are simple segues to start the dialog. When sharing the information, use language that the patient can understand. Choose your words carefully. Be realistic and yet offer hope. Make sure that they understand what you have told them.
EMPATHY – Patients respond to bad news in different ways. Make sure to be silent for a few moments to allow them to absorb the information. Allow them to express their emotions and show empathy towards them whatever their response may be. Don’t leave suddenly or become defensive. Allow them to express their feelings.
STRATEGY or SUMMARY – Make sure the patient has understood what you have told them. If possible, include them in determining the next step in the care plan. Explain the resources available to them, such as social services, chaplains, specialty nurses and dieticians.
Since these conversations are stressful, sometimes even painful, remember to give yourself time to decompress afterwards. Not addressing the emotions that delivering bad news can lead to burnout, which is not good for you or your patients. Remember to take care of yourself too!
