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Table 4 SPIKES tool in the disaster setting

From: How to talk with dying patients and their families after disasters and humanitarian crises: a review of available tools and guides for disaster responders

  Acronym Description of steps Example phrasing
S Setting up the interview --Arrange for some privacy --Involve family members (if desired) --Sit down --Make connection with the patient --Manage time constraints and interruptions  
P Assessing the patient’s perception --Ask, tell, ask (before discussing medical findings, use open-ended questions to understand the patient/family’s perception of their situation) --Allows clinician to correct misinformation and tailor the bad news to where the patient/family’s understanding is --“What is your sense of how your mother is doing?”
I Obtaining the patient’s invitation --Ask permission before giving the news --Assess through a cultural guide /interpreter/ family members how much a patient wants to know --“Would it be okay if I talk to you about what’s happened with your mother’s injuries?” -- “Is there anyone else who should be here for this conversation?”
K Giving knowledge and information --Give a warning shot --Give key information in concise, simple language -Stop talking --“Unfortunately I have some difficult news to tell you.” --“Because of the damage to your leg, it will require amputation above the knee.” --(Pause)
E Addressing the patient’s emotion with empathic responses --Allow for silence --Name the emotion --Align with the patient --“You seem devastated to hear this.” --“I really wish we had a treatment to save your father’s life.”
S Strategy and summary --Map out what is most important to the patient --Make a recommendation --“Given this hard situation, what’s most important right now?” --“In light of what you told me about your mother not wanting to suffer, I recommend that we give her medication to treat her pain and focus on her comfort.”
  1. (Source: adapted from Baile et al. 2000)