How to Give Bad News to Patients: The SPIKES Protocol

A simple chair (and if this link doesn’t work, see alternate below)

This outstanding presentation by Dr. Marcy Rosenbaum is a University of Iowa product with multimedia that may work best with any of a number of web browsers so experiment with IE 9, Firefox, Safari, or Google Chrome. You’ll need Quick Time player and if you get a message box that says something MIME–trying clicking “No” if clicking “Yes” causes the application to hang. It can take a minute to load. As physicians, we’re typically not trained to give bad news and many of us avoid this interaction. Marcy shows us how to apply the SPIKES protocol, which can make this painful process a little easier [1].  And there are many kinds of  bad news that clinicians may have to give. We may have to tell patients they have life-threatening diseases, or that they have to be moved from a general medical unit to a locked psychiatric unit for safety reasons, or that we have to get a court order to do that, and so on.

And if that link doesn’t work, here is another presentation which is excellent as well:

1. Baile, W.F., et al., SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer. Oncologist, 2000. 5(4): p. 302-11.

Author: Jim Amos

Dr. James J. Amos is Clinical Professor of Psychiatry in the UI Carver College of Medicine at The University of Iowa in Iowa City, Iowa. Dr. Amos received a B. S. degree in Distributed Studies (Zoology, Chemistry, and Microbiology) in 1985 from Iowa State University and an M.D. from The University of Iowa in Iowa City, Iowa in 1992. He completed his psychiatry residency, including a year as Chief Resident, in 1996 at the Department of Psychiatry at The University of Iowa. He has co-edited a practical book about consultation psychiatry with Dr. Robert G. Robinson entitled Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry. As a clinician educator, among Dr. Amos’s most treasured achievements is the Leonard Tow Humanism in Medicine Award.