Communication Skills & General History Taking

Question 1

What is the SPIKES strategy for breaking bad news?

Answer 1

SPIKES strategy for breaking bad news
1. Introduction
2. Setting
3. Patient’s Perception
4. Invite patient to receive Information
5. Knowledge transmission
6. Explore Emotions and Empathise
7. Summarise and Strategise

Question 2

What is the S in SPIKES?

Answer 2

S: SETTING UP THE INTERVIEW
Personal Preparation: Is the patient expecting bad news? Should anyone else be present, such as a relative, nurse or interpreter? Have I sufficient time to spend with the patient? Can someone else answer my mobile for an hour?
Ensure privacy and the comfort of the surroundings with adequate seating, appropriately arranged. Try to get some information about what is culturally acceptable for giving bad news before seeing the patient and/or family.

Question 3

What is the P in SPIKES?

Answer 3

P: PERCEPTION
Assess the patient’s perception of the illness. Invite the patient to give a summary of the illness to date and make sure you understand his/her perspective.

Question 4

What is the I in SPIKES?

Answer 4

I: INVITATION
Invite the patient to say what he/she wants to know and how the information should be given.
Ask if the patient is ready to talk about the illness and offer to answer questions if the patient prefers that approach

Question 5

What is the K in SPIKES?

Answer 5

K: KNOWLEDGE
When giving the patient knowledge about his/her illness, preface the disclosures with a warning about the possibility of bad news. As well as giving information, invite feedback and address the patient’s concerns. Avoid jargon and make sure you use language that the patient understands. Have reputable sources of information available, either printed or on websites.

Question 6

What is the E in SPIKES?

Answer 6

E: EMOTIONS
Accept that emotional reactions are normal, acknowledge them and encourage full expression with empathic responses. If there is anger directed at you remember that it is the patient’s problem, not yours and allow the patient to rage until all the anger is vented. If the patient hints at suicide, make your concerns explicit and reassure the patient that you are not abandoning him/her and that you will do your best to relieve symptoms and maintain a quality of life for however long is necessary. Ensure that adequate support is available if the patient is not admitted. If the patient shows little or no emotion, encourage him/her to describe current thoughts and feelings. If the patient says he/she is feeling ‘numb’ and seems unable to get beyond this, suggest that feelings might arise when the full import of the illness is realized. Offer to give them a waiting period and perhaps suggest an appointment the following day.

Question 7

What is the 2nd S in SPIKES?

Answer 7

S: SUMMARY
Briefly summarise the interview for the patient and outline the plan for the future. Offer regular reviews and plan for crises.

Question 8

What is the outline of a general history taking?

Answer 8

GENERAL HISTORY OUTLINE
1. History of Presenting Complaint - SOCRATES
2. Past Medical History
3. Medications
4. Allergies
5. Social History
6. Family History
7. Systems Review
8. Red Flags – Murtagh’s 7 question rule?
9. Final Question

Question 9

General history taking
* What questions should you ask about HxPC?
* What questions should you ask about PMH?
* What questions should you ask about Meds?
* What questions should you ask about Allergies?
* What questions should you ask about SocHx?
* What questions should you ask about FamHx?
* 7 Systems review Qs?

Answer 9