The SPIKES method was designed as a six-step protocol for delivering bad news and was published in The Oncologist 16 years ago. It also can work for approaching end-of-life discussions with patients whose frailty and multiple chronic illnesses suggest it’s time to discuss palliative care or even referral to hospice care.

Here’s how SPIKES works:

  • Step 1: S – Setting up: “The SPIKES method has to be in the right setting, where people are comfortable and can hear what you say,” says Mark D. Ensberg, MD, an associate professor of family medicine in the division of geriatrics at Michigan State University in East Lansing.
  • Step 2: P – Perception: “You should get a sense for where the person is at and how they see their situation,” Ensberg says. “Sometimes that can be quite different from the way the healthcare provider looks at it.”
  • Step 3: I – Invitation: Ask patients what they’re looking for or what they want to know, he says.
  • Step 4: K – Knowledge: Let people know where they are medically and what that means for them and their future. “At that point you can talk about end-of-life issues and options, the quality of life versus quantity of life, and what we can cure and fix and how much should be for comfort,” Ensberg says.
  • Step 5: E – Emotions: It’s challenging, but it’s also important to respond to patients’ emotions. “Sometimes people are more ready to discuss end-of-life issues than at other times,” he says.
  • Step 6: S – Strategy/Support: “Provide support and information that’s necessary and arrange for a follow-up,” Ensberg says.

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