A delicate situation encountered by
physicians is when they are called to break negative or bad news regarding the disease
to the patients and/or their families. “Bad news” may be defined as “any
information which adversely and seriously affects an individual’s view of his
or her future”.
For a healthcare-provider (HCP) treating
glaucoma, this situation can occur during the initial consultations itself,
when the visual prognosis is poor or guarded. Often, the patients consult an ophthalmologist when they are already in the advanced stage of the disease, in the hope of recovering their vision. While
others, follow a path of slow deterioration, losing a major part of their
visual field over time, despite adequate treatment by the ophthalmologist.
For a HCP, good communication skills are an
integral part of high-quality patient care. To be able to effectively convey
bad news can be a significant factor in improving the quality of life of the
patient.
Breaking bad news involves a twofold process
of finding appropriate kind words and understandable terminology, and the
secondary task of assessing how the patient and family are reacting, the degree
of distress that the conversation is inducing, and the subsequent tailoring of
information as the HCP responds to the assessment process. The last segment of this
communication is to move the patient and family from the bad news to the future
plans with realism and hopefulness.
In order of simplify the process of
breaking bad news a few strategies are being used. These include the SPIKE, BREAKS
and ABCDE protocols. The acronyms stand for SPIKE (Setting, Perception, Information,
Knowledge, Emotions & empathy, Support), BREAKS (Background, Rapport, Explore,
Announce, Kindling and Summarize), ABCDE (Advance preparation, Building
therapeutic relationship, Communication, Dealing with patient/family,
Encouraging emotional responses/outbursts & offering solutions).
The SPIKES strategy/protocol was designed
by Walter Baile and colleagues at the University of Texas MD Anderson Cancer
Center in USA, and is designed to offer HCPs an effective mechanism to
break bad news. The protocol focuses on the following steps:
- Establishing an appropriate setting.
- Checking the patient’s perception of the situation prompting the news regarding the illness or test results.
- Determining the amount of information known or how much information is desired.
- Knowledge of the medical facts and their implication before initiating the conversation.
- Exploring the emotions raised during the interview and responding with empathy.
- Establishing a strategy for support.
Subsequent posts on The Glog shall present
in detail the features of the SPIKES strategy.
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