As we get older, we become more vulnerable to serious health issues that may be difficult to treat or impossible to cure. When this happens, people differ in how much they want to know about their disorder and how it’s likely to progress. We rely on our doctors when it comes to “breaking bad news” and, of course, to correctly assess what we want to know.
A 2016 study revealed that many older adults with Alzheimer’s disease are never told their diagnosis by their doctor. As a geriatrician, I frequently have to tell patients that test results indicate they have Alzheimer’s or another type of dementia. In these situations, I tell the patient as much as he or she wants to know, being realistic about treatment and likely disease progression, while also trying to offer hope even if the long-term situation might be bleak.
6 STEPS OF “SPIKES”
The popular method for breaking bad news to patients uses the acronym SPIKES:
1. Set up interview with patient.
2. Perception of patient assessed.
3. Invitation from patient acquired by physician.
4. Knowledge and information provided to patient.
5. Emotions of patient addressed with empathetic responses.
6. Summary and strategy of diagnosis and treatment.
Despite my years of experience, breaking bad news is never easy, whether I’m seeing a patient I’ve known for years or providing a second opinion to a new patient. Less experienced doctors may feel uncertain about a patient’s expectations, may fear destroying a patient’s hope, and may not feel prepared to manage a patient’s anticipated emotional reactions.
However, we do have a protocol to guide us. It’s called SPIKES, and it consists of six steps that aim to gather information from a patient, explain the medical information to them, provide support, and involve them—and often their family—in developing a forward strategy. The latter is important, since patients who have a clear plan for the future are less likely to feel anxious and uncertain.
The “SPIKES” Protocol for Breaking Bad News
Many patients already have some idea about how serious their illness might be but are afraid to broach the topic or ask about the possible outcomes. Open-ended questions can help doctors assess how accurately patients perceive their medical situation—for example, “What do you think may be causing the symptoms you’ve been having?” or, “What have you been told about your condition so far?”
A doctor then might invite the patient to decide whether he or she wishes to be further informed about a diagnosis. Questions we may use to ascertain a patient’s wishes might include, “Would you like me to tell you what the problem is?” or “Would you rather I speak with your family, or that they be here when we discuss your test results?”
How to Take Bad News? It’s Different for Everyone
Receiving bad news about your health can be overwhelming, particularly if you are told that you have Alzheimer’s disease or a cancer. There will be decisions to make and next steps to take, and you should take the time to digest what you’ve heard.
At the same time, it is important to keep in mind that just as you have the right to know about your health status, you also have the right not to. You can relay this to your doctor, and also ask that he or she keep your family informed if you would rather not know the details yourself. However, the information may be crucial in allowing you to plan for the future, and to make the very most of your time with your family.
An official diagnosis also can come as a relief—there is a reason for your symptoms, and now you can work with your doctor and family on the next steps. But remember, it’s in your hands. Let your doctor know ahead of time whether you want information, and if there are others you want with you when you receive the information.
This article was originally published in 2017. It has since been updated.
Rosanne Leipzig, MD, PhD, is Professor and Vice Chair of the Brookdale Department of Geriatrics and Adult Development at the Icahn School of Medicine at Mt. Sinai in New York, N.Y. She also serves as Editor-in-Chief of the monthly publication Mount Sinai School of Medicine Focus on Healthy Aging. Visit her website at rosannemd.com.