Breaking bad news and communication in the emergency department — the SPIKES framework

Also known as SPIKES protocol · Breaking bad news · Death notification · Open disclosure · Goals-of-care discussion

Breaking bad news and difficult communication in the emergency department — the SPIKES six-step protocol (Setting, Perception, Invitation, Knowledge, Emotion, Strategy/Summary), the governing principles of privacy, protected time, sitting down, silence, empathy and the warning shot, and the four high-stakes ED scenarios of death notification, the peri-arrest goals-of-care discussion, the medical-error disclosure and the new life-changing diagnosis. Covers the symptom-control pharmacology of the peri-arrest and dying patient, cultural considerations, open-disclosure obligations, and the clinician debrief and self-care. The framework is the centrepiece of the ACEM and FRCEM OSCE communication stations. ACEM-primary, globally tagged.

high23 referencesUpdated 26 July 202620 min readVerification in progress

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8 MCQs

Meet the patient

A 58-year-old woman is brought in by her husband with two weeks of painless jaundice and a six-kilogram weight loss. The CT today shows a pancreatic-head mass with liver metastases — likely metastatic adenocarcinoma. The husband has not been told the result, and the patient believes she has a gallstone. Before you say a word about the scan, you must ask what she already understands, sit down, silence the phone, and give the warning shot.^[1]

The two questions that govern every difficult conversation are the two SPIKES answers in sequence: what does the patient already know? (Perception) and how much do they want to hear now? (Invitation). Skip either, and the Knowledge step fails twice over — wrong order, wrong language.^[1]

References23Show

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