| SPIKES[1] | ABCDE[2] | GUIDE[3] | BREAKS[4] | Serious illness conversation guide[5] |
| S: Setting up the interview—arrange for privacy, sit down, manage interruptions. | A: Advance preparation—arrange a time, ask about a support person being present, ask what the patient knows. | G: Get ready—gather info, set up privacy and a quiet location, find out who needs to be there. | B: Background, knowing the background of the patient/family and the clinical problem. | 1. Set up the conversation - Introduce purpose
- Prepare for future decisions
- Ask permission
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| P: Assessing the patient's Perception—ask open-ended questions about how the patient perceives the medical situation. | B: Build a therapeutic environment/relationship—arrange a private, quiet place, reassure about suffering and non-abandonment. | U: Understand—ask the patient what they already know, then listen. | R: Rapport, build rapport, provide ample space and time. | 2. Assess understanding and preferences |
| I: Obtaining the patient's Invitation—how would the patient like the information disclosed. | C: Communicate well—be direct, avoid jargon, allow for silence. | I: Inform—deliver the news in a single sentence, then listen. | E: Explore, start with what the patient knows. Involve other family or support as per the patient's preference. | 3. Share prognosis - Share prognosis
- Frame as a "wish…worry," "hope…worry" statement
- Allow silence, explore emotion
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| K: Giving Knowledge and information to the patient—use nontechnical words and give information in small chunks. | D: Deal with patient and family reactions—assess patient reactions, listen actively, explore feelings, express empathy. | D: Deepen—observe and respond to emotions by acknowledging them; can give silence if the patient has turned away. | A: Announce, give a warning shot, then deliver the news using straightforward language. | 4. Explore key topics - Goals
- Fears and worries
- Sources of strength
- Critical abilities
- Tradeoffs
- Family
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| E: Addressing the patient's Emotions with empathic responses—observe for emotion, identify it and its reason, let the patient know you've made this connection. | E: Encourage and validate emotions—correct distortions, evaluate the effect of the news, address further needs, arrange follow-up. | E: Equip—map out the next steps. Describe treatment options if you can. | K: Kindling, address emotions as they arise. | 5. Close the conversation - Summarize
- Make a recommendation
- Check in with patient
- Affirm commitment
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| S: Strategy and Summary—discuss the plan going forward and summarize the discussion. | | | S: Summarize, give a summary of the session and set up treatment/care plans. | 6. Document your conversation |
| | | | | 7. Communicate with key clinicians |
