Registered Nurses' Association of Ontario

SPIKES: Six Step Strategies for Delivering Bad News

1.      S – Set up the Interview
a.       Arrange for a private location to meet.
b.      Involve significant others.
c.       Sit down and try not to have barriers between you and the patient.
d.      Make connection through eye contact and touch.
e.       Manage time constraints and interruptions.
2.      P – Assess the individual’s perception
a.       Use open-ended question, i.e. “What have you been told about …” or “What is your understanding of …”
b.      Correct misinformation and tailor bad news to the individual’s understanding.
3.      I – Obtain the individual’s invitation
a.       A person’s desire for information may lessen his/her anxiety associated with the bad news.
b.      If information is not desired, offer to answer any questions.
4.      K – Give knowledge and information to the individual
a.       Provide warning that bad news is coming, to lessen the shock that follows the disclosure of bad news.
b.      Assess the level of comprehension and vocabulary of the individual.
c.       Use non-technical terms.
d.      Avoid excessive bluntness.
e.      Give information in small chunks and check periodically regarding patient/caregiver understanding.
5.      E – Address the individual’s emotions with empathic responses
a.      Observe for any emotion experienced by the individual.
b.      Identify emotions experienced by the individual.
c.       Identify the reason for the emotion.
d.      Connect the emotion by making a connecting statement, such as “I am sorry about                   . I know this is not what you want to hear. I wish the news were better.”
6.      SStrategy and summary
a.       Establish clear plan for the future, to lessen feeling of anxiety and uncertainty.
Clinical Management
End-of-Life Care During the Last Days and Hours
Point of Care Resources