Table 4 SPIKES tool in the disaster setting

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.”