How to brek bd news hs been explined.

1. BY-
DR.RITA SINGH
QUALITY COORDINATOR
GBHGC
SPIKE MODEL FOR ENHANCED
COMMUNICATION TO BREAK BAD NEWS AND
UNACCEPTABLE COMMUNICATION

2. SPIKES MODEL
STEP-1
S SETTING UP the interview with patient
STEP-2
P Assessing the patient’s PERCEPTION
STEP-3
I Obtaining the patient’s INVITATION
STEP-4
K Giving KNOWLEDGE and information to the patient
STEP-5
E Addressing the patients EMOTIONS with empathic
responses
STEP-6
S Strategy and Summary

3. Step-1 SETTING UP the interview with
patient
 AIM- To get physical context right , maximise privacy
, avoid interruption , help patient listen and
understand , respect confidentiality and provide
support.
 `Make sure you have checked all the available
information and have test results (incuding right pt).
 Use general terminology
 Arrange for some privacy
 Always have a helping nurse along to deal with
emotions of patient/family.

4. STEP-2 Assessing the patient’s
PERCEPTION
 Find out how much the patient knows.In particular
how serious he/she thinks the illness is or how
much it will affect in future.
 Verbal(words that pt uses to convey emotion) and
non-verbal (body posture , hand movements )
indicates anxiety. Try to make them better.

5. STEP-3 Obtaining the patient’s
INVITATION
 Try to find out how much the patient want to
know. Although this is a controversial issue.
 Guidelines for informed consent indicates
information which patient need to make informed
decisions.EQUALLY RESPECTING
PATIENTSAUTONOMY also means that pt’s have
right not to know or want to hear information.
 The challenge in communication is how to know
what a pt wants and also how to ensure that
there are other opportunities if a pt decides at
present that he/she does not wish to know all the
details.
 The doctor must fully inform the pt.

6. STEP-4 Giving KNOWLEDGE and
information to the patient
 First decide on the objectives for consultation.
 The 4 crucial headings are-Diagnosis , Treatment
plan , prognosis and support.
 Use warning shot as “ well , the situation does
appear to be more serious than that”.
 Give information in small chunks.
 ALWAYS CHECK RECEPTION AND
CLARIFY.EG- “AM I MAKING SENSE?’
 listen to pt’s agenda-their concern , buried
questions in their mind.

7. STEP-5 Addressing the patients EMOTIONS
with empathic responses
 Respond to pt’s feelings . This is a difficult
challenge in breaking bad news.
 Patient’s responses can vary from silence to
distress , denial/anger.
 Observe the pt and give them time.
 Acknowledge any shock and ask them what they
are thinking /feeling.allow silence.
 Empathy allows the patient to express their
feelings and worries and provide support.
 Do not argue.
 Allow expression of emotion without criticism.

8. STEP-6 Strategy and Summary
 Planning and follow-through.
 Patients will be looking to health professionals for
help in making sense of the confusion and
offering plans for future.
 Invite questions from patients.
 Tell them what happens next.
 When a pt has left…Check your own feelings.

9. UNACCEPTABLE
COMMUNICATION
 Using abusive language
 Wrong attitude
 Violent behaviour
 Hurting religious sentiments
 Communicating with disrespect
 Monotonous voice
 Mumbling
 Offensive gesture
 Unwanted/abusive remarks of sexual nature

10. THANKYOU