Breaking Bad News Station: SPIKES Approach and Key Considerations

Examiner feedback from the free mock session conducted on 17/06/2024

Overview

• Goal: Deliver a difficult prognosis (in this case, terminal dementia) with sensitivity and clarity.

• SPIKES Framework:

  • S: Setting (ensure patient comfort and privacy)

  • P: Perception (assess patient's understanding of the condition)

  • I: Invitation (ask if the patient wants anyone else present)

  • K: Knowledge (provide information in a layered, empathetic way)

  • E: Emotions & Empathy (acknowledge and validate the patient's feelings)

  • S: Strategy & Summary (outline the plan and offer support)

Specific Feedback and Tips

• Data Gathering:

  • Focus: Prioritize information directly relevant to the diagnosis and management plan.

  • Key Questions:

    • How much does the patient understand about dementia?

    • Who is the primary caregiver and what support do they have?

    • What has the patient been told so far?

• Perception:

  • Bridge the Gap: Help the patient connect the symptoms (weight loss) to the underlying condition (dementia).

  • Explain: Dementia is progressive, irreversible, and weight loss is a terminal symptom.

• Invitation:

  • Normalize: Offer the option for someone else to be present, but don't dwell on it if the patient declines.

  • Transition Smoothly: If the patient declines, move directly into providing information.

• Knowledge Delivery:

  • Layer Information: Connect weight loss, dementia, and its terminal nature.

  • Emphasize: Explain why further aggressive treatment is not beneficial.

  • Reveal Diagnosis: "Unfortunately, this is the terminal stage of dementia."

  • Emotions & Empathy:

  • Pause: Allow the patient time to react after the diagnosis.

  • Validate: Acknowledge their emotions and offer support (e.g., tissues, water).

  • Check In: Ask if they're okay to proceed.

• Strategy & Summary:

  • Introduce Palliative Care: Explain its focus on comfort and symptom management.

  • Address Concerns: Be prepared for questions about treatment options, going home, etc.

  • Offer Support: Provide information on hospice, support groups, or other relevant resources.

• Closing:

  • Summarize: Briefly recap the key points.

  • Follow-Up: Offer to arrange a meeting with their GP or other healthcare providers.

  • Provide Resources: Offer pamphlets or leaflets on palliative care.

Additional Tips

• Time Management: Be mindful of time constraints and avoid unnecessary data gathering.

• IPS: Demonstrate empathy and concern throughout the interaction.

• Tailor Your Approach: Be prepared for different patient reactions and adapt your responses accordingly.