A 45-year-old woman returns to the outpatient clinic to review the results of a recent breast biopsy. The pathology report confirms a diagnosis of invasive ductal carcinoma. The physician prepares to deliver this bad news to the patient. Arrange the following physician statements in the most appropriate chronological order according to the established framework for delivering bad news (the SPIKES protocol).
- 1"Please have a seat. I have made sure we have uninterrupted time to go over your results together."
- 2"Before we discuss the report, could you tell me what you understand so far about why the biopsy was performed?"
- 3"Are you someone who likes to know all the specific medical details, or would you prefer focusing on the big picture?"
- 4"I am sorry to have to tell you this, but the results show that the lump is breast cancer."
- 5"I know this is not the news you wanted to hear, and it is completely understandable to be shocked."
- 6"Whenever you feel ready, we can discuss our treatment plan and arrange a consultation with oncology."
Answer
The correct order follows the SPIKES protocol: Setting up the interview, assessing the patient's Perception, obtaining an Invitation, giving Knowledge, addressing Emotions, and establishing Strategy and Summary.
The correct order follows the SPIKES protocol for delivering bad news. First, the Setting (S) must be optimized for privacy. Next, the physician assesses the patient's Perception (P) of the situation. Then, an Invitation (I) is obtained to determine how much detail the patient desires. Only after these preparatory steps is Knowledge (K) imparted, giving the diagnosis clearly. Following the news, the physician must address Emotions (E) empathetically. Finally, Strategy and Summary (S) are discussed to formulate a plan moving forward.
Step-by-Step Solution
Key Concept
The SPIKES protocol for delivering bad news
Estimated Time:1m 0s