The SPIKES communication framework in clinical practice

S Activity 4:the
SETTING UP Communication
conversation principles continued
 Choose a setting with privacy and without interruptions, ensuring that you have:
The SPIKES communication framework 3. Providing support
 A private space
The SPIKES
 Turned Protocol
phones isto
commonly
silent used 4. Eliciting the person’s collaboration
for fulfilling one pagers
Turned of theoff communication in developing a strategy or treatment
elements in palliative
 Allowed caretime
sufficient – breaking bad
for the conversation plan for the future.
news.The Helpway
thebad news
person is communicated
to understand what they are hearing by confirming and explaining
can enhance or facts
hinder the understanding Although some of the steps of SPIKES
medical
of prognosis and are similar to the steps in PREPARED,
 Check the treatment
accuracy of alloptions,
available information – including test results and that you
and the person’s adjustment SPIKES concentrates on delivering bad
have the right person to their
news (such as the initial diagnosis), while
 PlanTHE
situation. whatSPIKES
you will steps can
[2]
say
complement the PREPARED framework PREPARED focuses on the holistic support
 Decide on general terminology to be used
by assisting with the four most important of the person and their family throughout
 Consider your own emotional reaction to providing the distressing news
objectives of breaking bad news: their illness and can be used to frame
 Find out in advance if the person wants anyone else discussions in a range of palliative
to be present.
1. Gathering information
 Find out if the person requires a professional interpretercontexts. [4–7]
to be present and, if
2. Transmitting
so, arrangemedical
for this information
ahead of time. Using family or friends as interpreters is not
recommended for conversations about health matters.
The SPIKES communication framework
The more reassured you feel about the setting the more at ease, available and
helpful, you will appear to the person.
S Setting up the conversation
P Assessing the Person’s PERCEPTION
P Assessing the person’s perception
 Find out how much the person knows already – in particular, how serious they think
I Obtaining
the illnessthe person’s
is and invitation
how much it will affect the future. This helps you gauge how close
to the medical reality their understanding is – or if they are in denial
K Providing knowledge and Information to the person
 “What do you understand about your illness?”
E Addressing
 “What havethe
youperson’s
been toldemotions with
you so far?” empathic responses
S Strategy
Look forand Summary
emotional cues and body language. Verbal and non-verbal cues can
indicate possible anxiety levels and comprehension about the information you
Click for have
a summary
provided:of how the SPIKES communication framework can support clinical
practice.
 “Where do you think you are up to in regard to your health?”

 ”What is your understanding of the situation and its potential outcomes?”

It is important to note that these frameworks are guides only and not prescriptive
This information helps you to decide on the pacing and content of the
checklists for having a conversation with a person affected by a life-limiting illness.
conversation.
Use the steps in the frameworks to guide your interactions and to assist you
in planning and preparing for difficult conversations.

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2020 Module 2: Communication PCC4U Implementation Guide I Learning Resource I 2020 67
 I Obtaining the Person’s INVITATION
Activity 4:what
 Find out Communication
the person wants to knowprinciples continued
– you must be committed to honesty and
respecting their wishes if they do not want to be informed. Pacing and phrasing of
The SPIKES communication
questions are geared to framework
this goal 3. Providing support
 “Would
The SPIKES it be okay
Protocol to talk about
is commonly this now?”
used 4. Eliciting the person’s collaboration
 “How much would you like to know?”
for fulfilling one of the communication in developing a strategy or treatment
 Find
elements out what they
in palliative carealready know bad
– breaking plan for the future.
news. The
 way bad
Explore how news is communicated
much detail they would like
can enhance
 “Do or youhinder
like thethe
big understanding
picture or the details?” Although some of the steps of SPIKES
of prognosis
 “If thisand treatment
turns something serious are youare
out to beoptions, thesimilar
kind of to the who
person steps in to
likes PREPARED,
know exactly what’s
and the person’s adjustment to their going on” SPIKES concentrates on delivering bad
 “Would you like me
situation. [2] THE SPIKES to tell
steps canyou the details of the news (such as the initial diagnosis), while
diagnosis?”

complement
 Consider
the any cultural variations
PREPARED frameworkthat are required PREPARED focuses on the holistic support
by assisting
 Givewith the four
the person most
control important
over hearing the news:
of the person and their family throughout
 Allow
objectives the personbad
of breaking news: decline to receivetheir
to voluntarily illness and can be used to frame
information
discussions
 Allow the person to designate someone to communicate on their in abehalf.
range of palliative
1. Gathering information
K Providing KNOWLEDGE and Information to the Person contexts. [4–7]

2. Transmitting medical information

 Decide on the objectives for the conversation

The SPIKES communication

 Consider framework
what the person knows and needs to know in order to work with you in
managing their illness, including:
S  Diagnosis
Setting up the conversation
 Treatment Plan
P Assessing the person’s perception
 Prognosis
I Obtaining
 Support the person’s invitation
K Providing
Give the knowledge
person and Information to the person
a warning:
 “It’s not what we hoped for I’m afraid . . .”
E Addressing the person’s emotions with empathic responses
 “I have something serious to discuss with you”
S 
Strategy and Summary
“Well, the situation does appear to be more serious than that”

Click for Provide information

a summary of howin the
smallSPIKES
chunks communication framework can support clinical

practice.Be clear and direct



 Use plain language

It is important to note that these frameworks are guides only and not prescriptive
 Avoid jargon, complex medical terminology and acronyms
checklists for having a conversation with a person affected by a life-limiting illness.
Use the steps in the frameworks to guide your interactions and to assist you
 Check understanding often and clarify where required
 “Am I making sense?”
in planning and preparing for difficult conversations.
 “This might be a bit confusing; do you roughly follow what I’m saying?”
 Repeat important points (people who are upset or shocked don’t hear or
remember well)
 Use diagrams, written messages and pamphlets as an aid
 Respond to concerns and questions.

68 PCC4U Implementation Guide I Learning

66 Retrieved
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2020 Module 2: Communication
 E Addressing the person’s EMOTIONS with empathic responses
Activity 4:theCommunication
 Observe person and give them timeprinciples continued
to react and comprehend the news
 Acknowledge any emotional response without criticism or blame:
The SPIKES communication framework 3. Providing support
 “I can see that this is making you angry”
The SPIKES
 “I canProtocol
see thatisthis
commonly used for you” 4. Eliciting the person’s collaboration
is really upsetting
for fulfilling onesee
“I can ofthat
theyoucommunication
are really worried about . . .” in developing a strategy or treatment
elements in palliative care – breaking bad
 Ask the person what they are thinking or feeling: plan for the future.
news. The“What
way bad news
are your is and
fears communicated
what are your hopes?”
can enhance or hinder the understanding Although some of the steps of SPIKES
 Listen and explore if you are unclear about what they are expressing
of prognosis and treatment options, are similar to the steps in PREPARED,
 Respond empathically
and the person’s adjustment to their SPIKES concentrates on delivering bad
 Resist the temptation to make the distressing news better than it is
situation. [2] THE SPIKES steps can news (such as the initial diagnosis), while
 Allow time for silence.
complement the PREPARED framework PREPARED focuses on the holistic support
S by assisting
Strategywith
and the
Summary
four most important of the person and their family throughout
objectives of breaking
 Demonstrate bad news:
a genuine their illness
understanding of the person’s and can be used to frame
concerns:
 “How are you going to tell your spouse? Would you like me to in
discussions a range of palliative
help?”
1. Gathering information
 “What are your concerns? Do you want to talk about contexts. [4–7]
them?”
2. Transmitting medical information
 Distinguish the fixable from the unfixable

The SPIKES communication framework

 Make a plan or strategy and explain it by providing information on tests, treatment

options, referrals and other aspects of care

S Prepare
Setting upforthe
theconversation
worst and hope for the best:
 “Let’s plan for the worst but hope for the best”
P Assessing the person’s perception
 Identify coping strategies for the person and suggest other sources of support that
I Obtaining the person’s
they can access invitation
(this includes referral to other services)
K Providing knowledge
Explain what and
happens next Information to the person
E Addressing
Schedule a the person’s
follow emotions
up appointment withthey
so that empathic
have theresponses
opportunity for further
questions.
S Strategy and Summary

Click for a summary of how the SPIKES communication framework can support clinical
practice.

It is important to note that these frameworks are guides only and not prescriptive
checklists for having a conversation with a person affected by a life-limiting illness.
Use the steps in the frameworks to guide your interactions and to assist you
in planning and preparing for difficult conversations.

66 PCC4U Implementation Guide I Learning

Retrieved
Resource
from: IPCC4U
2020 Module 2: Communication PCC4U Implementation Guide I Learning Resource I 2020 69