How to Share Bad News With Patients Using the SPIKES Protocol

How to Share Bad News With Patients Using the SPIKES Protocol

Your experience in the medical field will be full of many ups and downs.

As a new nurse, you would have likely entered the field because you feel rewarded for helping people.

When you’ve successfully treated a patient or made them feel comfortable or shared the good news about their condition, you feel joy as you see them smile and be hopeful.

These moments are what make nursing a fulfilling experience.

Unfortunately, not all moments facing patients will be positive.

Sometimes, you’ll have people in severe discomfort or certain states, making them hostile or potentially violent.

At other times, you will have patients with whom you have to share bad news.

In a patient-facing role like yours, you won’t always have good news to share with them about their health.

When patients come to you feeling pain or discomfort, they will have tests taken, which may reveal some worse results than they would have anticipated.

Or, you could have people under your care who you may need to inform that they have no more options in their treatment plan because their condition is too powerful.

Sharing difficult news to your patients is a challenging part of your role.

Use the SPIKES protocol for nurse practitioners to help you effectively break the bad news to patients.

S- Set Up the Interview

While usually, physicians are the people who determine diagnosis or treatment plans, you will likely hold the responsibility of informing patients about them, especially if you’ve built a connection with them over time and know about their situation first-hand.

The “S” in the SPIKE Protocol guides you through setting up the conversation so your patients and their family can be emotionally prepared before you break the bad news.

This allows a designated time in your own scheduling, and theirs, to have a conversation about their future.

Your role will be to guide and inform them of all details so your patient fully understands what is happening and what they can expect.

With this information, they can eventually accept what you’ve shared.

Before your meeting:

  1. Make sure you’ve gathered all information about their diagnosis or
    condition or their treatment plan.

  2. Be ready for whatever questions they may have so you can hold a productive

  3. Choose a private area where they can sit down while you share your news.

P- Patient Perception Assessment

Before you break the bad news, learn how your patient perceives their situation and whether they’re emotionally prepared for what you’re about to tell them.

You’ll want to know if they were ever informed of the worst outcomes from their diagnoses or if they know anything about the medical condition you’ll be telling them about.

Ask open-ended questions so you can gauge what your patient understands around their medical state.

I-Obtain the Patient’s Invitation

As you enter your discussion with the patient, learn how much information they’re comfortable receiving in your session.

Do they want to have a long conversation to learn every minor detail and potential outcome of their diagnosis?

Or, would they rather hear the news in basic terms to slowly process and accept their future?

This may be a challenging stage to find the proper balance of giving the appropriate information load that they need to truly understand the situation—especially if it requires the patient to make an informed decision about how to move forward while honoring how much they want to take in at once.

Be considerate, but commit to the goal of sharing a complete picture of the news you’re telling them.

K-Share Knowledge and Information

With the initial bad news shared, you will be the resource of any further details that your patient will want to know.

Make sure you’re well-researched in the condition and have spoken with the physician who performed the diagnosis, so you know of all treatment plans and outcomes, or if the patient is dying with no options left, what they can do to be comfortable in this stage.

When sharing information, make sure you are clear and to the point.

Avoid medical jargon and use simple terms for non-medical experts to understand.

Walk through all reasoning, so your patients will understand the “why” and “how” of their condition.

Your job is to ensure the patient fully understands what is happening.

E- Be Empathetic When Addressing Patient Emotions

One major requirement for your conversation or patient treatment following breaking the bad news is empathy.

You must be understanding of your patient’s outlook and respond professionally while also being human.

Observe how your patient reacts, or ask them, and express your empathy.

That way, they’ll feel validated for how they’re feeling.

Be supportive and share realistic words of encouragement.

Do not simply say “it will be okay” or “don’t cry” because you may have told the patient things won’t be okay, which is a fair reason for them to cry, get angry, or experience shock.

The best comfort you can offer in this conversation is being present and empathetic.

S-Share a Strategy and Summary

When finishing your conversation, you will want to have a plan in place to help your patient know where to go and what to do with the information you’ve shared.

Having a strategy will offer guidance and perhaps some hope too.

Whether your conversation was long or brief, make sure you summarize all the key points and details that are essential for the patient to understand moving forward.

Do not make false promises you can’t keep, like making them better when there are no treatment options left.

Allow your patient to offer input in their plans moving forward, express any emotions or concerns, and ask all the questions they want to better help them understand their situation.

By following the SPIKES method, you can approach effectively sharing bad news.

These steps will guide you by sharing all the details they need professionally while being empathetic and considering how your patient feels when hearing the news.

Be their resource to avoid the stress of asking multiple experts different questions.

Stay closely in touch with the physician involved in your patient’s situation, and keep track of their treatment or care process.

By being there through all steps, you could be the positive light in a difficult situation,

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