In palliative care the ability to communicate effectively with patients and families can no longer be thought of as an optional skill.
Although different studies show that communication skills can be taught and are retained, many professionals report a lack of confidence in their ability to break bad news. The specific lack of training opportunities play a major role in leading to this problem: most professionals not only have no didactic training but also do not have an opportunity to gain experience from observing other clinicians breaking bad news.
The SPIKES protocol for breaking bad news is a specialized form of skill training in physician–patient communication, which is employed in teaching effective communication skills.
The six steps of SPIKES
Each step is associated with specific skills; not every episode of breaking bad news will require all of the steps, but when they do they are meant to follow each other in sequence.
Step 1: Setting up the interview.
Step 2: Assessing the patient’s Perception.
Step 3: Obtaining the patient’s Invitation.
Step 4: Giving Knowledge and information to the patient.
Step 5: Addressing the patient’s Emotions with empathic response.
Step 6: Strategy and Summary.