Spikes checklist

Template Questions

• Breaking Bad News
• The aim for any health-professional is to use their skills to deliver bad news clearly, honestly and
• SPIKES - The Six-Step Protocol for Delivering Bad News
• S = SETTING Up The InterviewThe aim of this is to get the physical context right, maximise privacy, a
• All information and test results have been reviewed?
• Team member ensures adequate privacy for the patient and their relatives?
• Were the introductions and opening comments appropriate? Is there anything you would change or add?
• P = PERCEPTION of Condition/SeriousnessFinding out how much the patient knows. In particular how seri
• Team member uses open ended questions to verify relatives understanding. ie. "What have you made of the illness so far? "What did doctor X tell you when he sent you here?"
• Does the patient/relative show any signs of avoiding terminology or phrases? Are they possible signs of anxiety? (Body posture, hand movements could also be indicators)
• Team member does not necessarily need to correct these behaviours, but could be useful observations i
• In any conversation about bad news the real issue is not "Do you want to know?" but "at what level do you want to know?"
• How would you gauge your own understanding of informed consent with regards to a patient being able to make informed decisions? (1 = no understanding, 10 = complete understanding)
• Do you believe a patient has the right not to know the details of their condition?
• It is important that the team member is able to elicit patient's wishes without imparting their own a
• How effective would you say the Team Member was at identifying the patient's wishes. Give an example of good practice or an area of improvement
• Are you able to photograph the groups dynamics to support your observation?
• "Would you like me to tell you the details of the diagnosis?"
• With all the best planning, the team members need to remain pliable to the responses and needs of the patient. Does the patient's needs alter the team's pre-empted agenda for the discussion?
• If so, please give us an example
• Mirroring the patients posture and terminologies used:
• How does the team member/s educate the patient and/or relatives about any misunderstandings or lack of clarity? Give examples.
• Responding to a patients feelings is one of the more difficult challenges in breaking bad news. Patie
• Does the Team Member -
• allow the patient time to process the information?
• Any further observations?
• Demonstrate an understanding of the patient's problem list
• In your own practice, when the patient has left:
• Remember to check your own feelings
• This brings us to the end of this peer observation and learning tool.
• Please sign off this observation
• Select date Date
• It can be useful to email a copy of this document to yourself and those that have been observed. Go to EXPORT document and ask all necessary personel to add their email.