Breaking bad news — SPIKES
What it means
A structured approach to delivering bad news: SETTING (private, uninterrupted, support present), PERCEPTION (ask what the patient already knows), INVITATION (ask how much they want to know), KNOWLEDGE (warning shot, then clear, jargon-free information in small chunks), EMOTIONS (acknowledge and respond empathically), STRATEGY/SUMMARY (plan and next steps). Pacing to the patient is central.
Worked example
Before giving a cancer diagnosis the doctor sets up a private space, finds out what the patient understands and wants to know, gives a warning shot, then the news in small pieces, responding to emotion.
In the exam
A doctor preparing to disclose a serious diagnosis arranges a private setting, checks what the patient already knows and how much they want to hear, then delivers the news in small chunks.
What settles it
Start by finding out the patient's PERCEPTION and INVITATION before giving information — tailoring to what they already know and want to know, not a fixed script.
Classically confused with
DNACPR / ReSPECT
Source: SPIKES (Baile et al.)