question 27

Question 1

breaking bad news cancer

Answer 1

• SPIKES:
  o Setting – privacy (private room, may need chaperone?), sitting down at same level as patient, look attentive and calm, listen, allow time. How has pt been?
  o Perception – ask what the patient knows and understands before you tell, “are you aware of what we’re here to discuss today? Do you know the reasoning for the biopsy? Explain to me your understanding of things up until now”
  o Invitation – obtain permission, “I’ve got the results of your tests here, is it okay with you if we discuss them now?”
  o Knowledge – give a warning, present news in patient’s language, avoid jargon, tailor rate of delivery/break it down, clarify patients understanding, allow time and periods of silence
   “I’m afraid the results from our biopsy aren’t good. The test has shown some abnormal cells, and I’m sorry to teel you that you have mouth cancer” pause
  o Empathy – emotional appreciation, put yourself in patients shoes, “im sorry, it must be very hard for you, I can see that you are upset by this news”
  o Summary and Strategy – summarise the information, allow time for Qs, ensure patient has a clear plan of what will happen next, give written information, reassure with support
   “Thankfully we have caught this relatively early and therefore we can move on with treatment as soon as possible