“E” in the SPIKES is for anticipating and addressing emotional reactions. This is the essential skill for meaningful conversations — empathy.
Looking at the original SPIKES protocol, an emotional reaction was anticipated after the doctor gave “bad news.” Bad news like “you have cancer” or “cancer has returned.” In day-to-day conversations, though, “bad news” isn’t always straightforward, as we discussed in the first post. Thus anticipating and identifying emotional reactions requires being attentive in the conversation. To watch for subtle changes in position, the tone of the voice, and obvious reactions like tears coming down the cheeks.
Once we have identified an emotion, how do you respond?
You do not need a doctorate to figure this out, as a matter of fact, it probably hurts if you have a doctorate. I tell my students that in four years of medical training, we make them machines - machines that spit out so many facts that spitting out facts becomes the goal rather than whether it is being heard. So,
If you give an amazing pathophysiology explanation on a topic (or question)
and no one actually ‘hears’ it, did you even say anything?
The answer is obvious and yet so often many of us forget this basic principle. The person must be ready to hear whatever we want them to hear it. We have to address “emotions before presenting facts.”
There are several ways we can convey that we are “listening” and “are present” in the conversation. Two of these are our actions and the third is our words (or combination of actions and words). The key to providing an empathic response is to be honest. Our actions and behaviors should be aligned.
Actions: Silence
The most effective action that we can take is to do nothing. Absolutely nothing. Just be silent, be still, and be present in this moment of the patient’s emotional reaction. There is no greater gift we can give than our presence.
I challenge my students to count the number of seconds they can be silent for (would love your responses in comments - what is the most you have been silent in a conversation?).
Actions: Touch
When appropriate, and if comfortable for you and the setting, expression of empathy can be — giving a tissue to someone in tears, extending a hand in support, or a hand on the shoulder. Be mindful of cultural norms (in many cultures touch from an opposite sex person can be frowned upon or worse yet, make the patient feel uncomfortable).
Actions: Words: NURSE
N: Naming an emotion
U: Understanding Statements
R: Respecting Statements
S: Supporting Statements
E: Exploring Statements
In this post, I will provide one example of each. We will spend significantly more time in future posts on each of these separately.
Naming an emotion:
“It seems like the results are upsetting”.
Understanding Statement:
“I can not imagine what it must be like to hear this information”
Respecting Statements:
“It has been amazing to watch you be present for your loved ones in these past x months/years”
Supporting Statements:
“I am going to be there for you through out your journey”
Exploring Statement:
“Can you tell me more about …”