SPIKES is a sequential strategy for breaking bad news, based on Robert Buckman’s work. The acronym stands for Setting up the interview, assessing the patient’s Perspective, obtaining the patient’s Invitation, giving Knowledge and information, managing Emotions with empathic responses, and strategy and Summary. It is used to structure difficult conversations by creating a private setting, checking how much the person wants to know, giving clear and understandable information, responding to emotional reactions, and agreeing on the next steps.

In practice, SPIKES provides a framework for breaking bad news in a sensitive and organized way. Its stages map onto the nursing-related headings described in the source: preparation, information giving, responding to reactions, planning the next step, and debriefing. Preparation involves ensuring a safe, private space, deciding who should be present, giving a warning that the discussion is about a specific important issue, and being well informed. Information giving means using clear language and avoiding ambiguous euphemisms, offering information in manageable chunks, checking understanding, and telling the person that support remains available. Responding to reactions involves allowing the person to express feelings, validating their distress or anger, and keeping the interaction open for questions. Planning the next step treats breaking bad news as a process, involving the patient and relatives where appropriate, and providing written information if useful. Debriefing addresses the emotional impact on nursing staff and should be supported by senior managers, especially for junior staff. These principles also apply to everyday bad news, such as cancelled surgery, where the impact on the individual should never be assumed.

Key points

SPIKES is an acronym: Setting, Perspective, Invitation, Knowledge, Emotions, Strategy/Summary.
Set up the interview by ensuring privacy, deciding who should be present, and giving a warning shot about the serious topic.
Assess the patient’s perspective and obtain their invitation before giving information.
Give knowledge clearly, avoiding euphemisms, and check for understanding.
Manage emotions with empathy by allowing expression and validating the person’s feelings.
Agree a strategy and summary, and plan next steps as part of an ongoing process.
In nursing, debriefing supports staff with the emotional effects of breaking bad news.

What is the SPIKES strategy for breaking bad news and how is it used?