Expansion
SPIKES: Setting, Perception, Invitation, Knowledge, Emotions, Strategy
Expansion
SPIKES:
- S - Setting: private, uninterrupted, sitting down, tissues available, ask whether they would like someone with them
- P - Perception: find out what they already know and believe. “What have you been told so far?”
- I - Invitation: ask how much they want to know, and in what detail
- K - Knowledge: give a warning shot (“I’m afraid the results are not what we hoped”), then the information in small chunks, in plain language, pausing frequently
- E - Emotions: respond with empathy. Allow silence. Name the emotion. Do not rush to reassure
- S - Strategy and summary: agree the next steps, offer written information, arrange follow-up and give a point of contact
Principles that matter more than the acronym
- Avoid jargon and euphemism. “Cancer” is clearer than “a growth” or “a shadow”
- Silence is therapeutic; the instinct to fill it should be resisted
- Do not give false reassurance, but do not remove hope. Hope can be reframed towards comfort, time and control
- Check understanding by asking the patient to summarise
- Document the conversation and who was present
Ask what the patient is most worried about; the answer is frequently not what the clinician assumed.