If you think about SPIKES, it was developed for oncologists giving “bad news.”
As oncologists, we are estimated to deliver “bad news” about 10,000 times in our careers. Well, that is A LOT.
But wait, is that really true? Is it more or less than what other doctors do?
Wait, how do you define bad news?
How do you define “bad” news?
So I hope you first reflect on this. How do you define it?
The original thought process is that any news of “new diagnosis,” “cancer recurrence,” “failure of therapy to control cancer,” or “stopping cancer-directed therapies” were defined as bad news.
If you think hard enough and step outside the above definition, “bad” is in the eye of the beholder. A question I ask my learners all the time…
My wife, Neha, is an outpatient pediatrician. How often does she deliver bad news? Thankfully, she does not need to give the news that a child has cancer often. She does, though, tell parents that their child has a contagious illness and they can’t go to school. Could that be “bad” news?
Yup, absolutely… if the parent can not find a caregiver, they may not be able to get to work and may not be able to keep their job… yup, that could be “bad” news.
So any conversation you have with a patient can possibly be bad news.
So, the first lesson is to always use the framework and skills. Do not reserve them for when you think a patient may perceive the information as adverse. Because we don’t, we can’t really know.
Lesson 1: Use this framework at all visits.
SPIKES stands for:
Setting up the Conversation
Assessing Perceptions
Obtaining Invitation
Giving Knowledge
Addressing Emotions (with Empathy)
Summarizing the conversations.
Whether it is discussing cancer progression in an oncologist’s office or “pink eye” in a pediatrician’s office, these skills are useful. More importantly, you can use these skills across multiple meetings.
An example may be that a patient with a new cancer diagnosis needs to understand their diagnosis, their prognosis, and their treatment options and make treatment decisions while keeping their values and preferences in mind. We need to help them with choosing from these options. All these tasks can take more than one meeting. So, each meeting can end with summarizing their understanding and start the next meeting with the same (hoping that what they recall at the second meeting is what was conveyed in the first meeting).
Lesson 2: Use this framework at each visit with each patient.
In the next few substacks, we will discuss each skill independently (S, P, I, K, E, and S).
While I learned and used this framework, there are other frameworks, too. Please share in the comments below what framework you use. Which framework do you teach your learners?
Biren Saraiya MD