The mnemonic "SPIKES" can summarize the theory of delivering bad news. The "SPIKES" of delivering bad news include Setting, Perception, Invitation, Knowledge, Emotions, and Strategy.
Setting up is the first step in delivering bad news. This step includes preparing what to say, where to say it, in what manner, and who to involve in the conversation. We need to show empathy in this process.
The second step is more about listening than giving information. We need to know the perception or perspective of the patient and family on any test result and what they are curious about.
Using open-ended questions is the best way to approach this step. An open-ended question is a question that cannot be answered simply with "yes" or "no."
This step to invites the patient or family to access information. We need to ask them permission, and they also have the right not to know some details if they are not ready for them.
We can ask permission from the patient and family after we gather information from the patient about their understanding of their illness.
In this step, we give the patient and family knowledge and information. We prefer to use plain terms, not medical jargon, so the patient and family can understand what we are saying.
Empathy should be the emotional reaction we have. We need to show understanding of patients' and families' emotions and treat them with respect.
Strategy is the last step in SPIKES and includes summarizing all of the conversations and planning, or strategizing, the next step.
Discussing treatment options will lead to the next step and future goals.
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