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Clin J Oncol Nurs. 2010 Aug;14(4):514-6. doi: 10.1188/10.CJON.514-516.

SPIKES: a framework for breaking bad news to patients with cancer.

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  • 1Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York, USA. marcellekaplan


SPIKES is an acronym for presenting distressing information in an organized manner to patients and families. The SPIKES protocol provides a step-wise framework for difficult discussions such as when cancer recurs or when palliative or hospice care is indicated. Each letter represents a phase in the six-step sequence. S stands for setting, P for perception, I for invitation or information, K for knowledge, E for empathy, and S for summarize or strategize. Breaking bad news is a complex communication task, but following the SPIKES protocol can help ease the distress felt by the patient who is receiving the news and the healthcare professional who is breaking the news. Key components of the SPIKES strategy include demonstrating empathy, acknowledging and validating the patient's feelings, exploring the patient's understanding and acceptance of the bad news, and providing information about possible interventions. Having a plan of action provides structure for this difficult discussion and helps support all involved.

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