Truth Telling: Yes, but How?

From Iusmphysiology

• Many physicians want to have the hard, truth telling conversations with patients but are stricken with an inability because they feel incapable; they have no method.
• Setting Perception Invitation Knowledge Emotion Strategy and Summary (SPIKES)
• Setting
  • Introduce yourself with a friendly smile.
  • Be sure you are in a comfortable, private setting with the patient and any supporters available.
• Perception
  • Ask the patient what they know about their condition and wait patiently and listen intently as they explain what they know.
  • Be sure to be seated with the patient.
• Invitation
  • Let the patient know that you would like to update them on their condition and give them some information.
  • Ask if this is OK with them, is the right time, etc.
• Knowledge
  • Give the information in small, simple chunks.
  • Ask if you are being clear and what the patient understands at regular intervals.
• Emotion
  • The key to handling the strong emotions that will come with hard conversations is to acknowledge each of these emotions--both the patient's and your own.
  • One way to acknowledge these emotions is called the empathetic response:
    • There are three steps to the empathetic response: verbalize the emotions being felt, recognize why they are being felt (usually the news being given), and then say something that connects the two: "I realize this news comes as quite a shock".
    • Using the empathetic model shows that you are tuned-in to their emotions as well as your own.
    • By addressing the emotion, the conversation around the consequences of the news is not escalated.
  • "Wish statements" have also been shown to be helpful; they show that your own emotions and desires align with the patient's.
• Strategy and summary
  • Close with a clear definition of the plan and a contract for the next appointment or visit.