Framework models for communicating serious news to patients and their families

SPIKES^[1]	ABCDE^[2]	GUIDE^[3]	BREAKS^[4]	Serious illness conversation guide^[5]
S: Setting up the interview—arrange for privacy, sit down, manage interruptions.	A: Advance preparation—arrange a time, ask about a support person being present, ask what the patient knows.	G: Get ready—gather info, set up privacy and a quiet location, find out who needs to be there.	B: Background, knowing the background of the patient/family and the clinical problem.	1. Set up the conversation Introduce purpose Prepare for future decisions Ask permission
P: Assessing the patient's Perception—ask open-ended questions about how the patient perceives the medical situation.	B: Build a therapeutic environment/relationship—arrange a private, quiet place, reassure about suffering and non-abandonment.	U: Understand—ask the patient what they already know, then listen.	R: Rapport, build rapport, provide ample space and time.	2. Assess understanding and preferences
I: Obtaining the patient's Invitation—how would the patient like the information disclosed.	C: Communicate well—be direct, avoid jargon, allow for silence.	I: Inform—deliver the news in a single sentence, then listen.	E: Explore, start with what the patient knows. Involve other family or support as per the patient's preference.	3. Share prognosis Share prognosis Frame as a "wish…worry," "hope…worry" statement Allow silence, explore emotion
K: Giving Knowledge and information to the patient—use nontechnical words and give information in small chunks.	D: Deal with patient and family reactions—assess patient reactions, listen actively, explore feelings, express empathy.	D: Deepen—observe and respond to emotions by acknowledging them; can give silence if the patient has turned away.	A: Announce, give a warning shot, then deliver the news using straightforward language.	4. Explore key topics Goals Fears and worries Sources of strength Critical abilities Tradeoffs Family
E: Addressing the patient's Emotions with empathic responses—observe for emotion, identify it and its reason, let the patient know you've made this connection.	E: Encourage and validate emotions—correct distortions, evaluate the effect of the news, address further needs, arrange follow-up.	E: Equip—map out the next steps. Describe treatment options if you can.	K: Kindling, address emotions as they arise.	5. Close the conversation Summarize Make a recommendation Check in with patient Affirm commitment
S: Strategy and Summary—discuss the plan going forward and summarize the discussion.			S: Summarize, give a summary of the session and set up treatment/care plans.	6. Document your conversation
				7. Communicate with key clinicians

References:

Baile WF, Buckman R, Lenzi R, et al. SPIKES—a six-step protocol for deliver bad news: application to the patient with cancer. Oncologist 2000; 5:302.
Rabow MW, McPhee SJ. Beyond breaking bad news: how to help patients who suffer. West J Med 1999; 171:260.
Back AL. (2013) Vital Talk (1.0) [Mobile Application Software] Retrieved from http://vitaltalk.org.
Narayanan V, Bista B, Koshy C. "BREAKS" protocol for breaking bad news. Indian J Palliat Care 2010; 16:61.
Serious Illness Conversation Guide (Accessed on October 16, 2017). This material has been modified by UpToDate. The original content can be found at https://www.ariadnelabs.org/ and is licensed by Ariadne Labs under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Ariadne Labs licenses the original content as-is and as-available, and makes no representations or warranties of any kind concerning the original content or concerning this material, which Ariadne Labs has not reviewed or endorsed.

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Framework models for communicating serious news to patients and their families