Delivering Bad News: A Crucial Conversation
Bad news has been defined as “any news that drastically and negatively alters the person’s view of her or his future”. A more inclusive definition of bad news is “…situations where there is either a feeling of no hope, a threat to a person’s mental or physical well-being, a risk of upsetting an established lifestyle, or where a message is given which conveys to an individual fewer choices in his or her life”.
The SPIKES model is based on a six-step protocol for delivering bad news.
1. Create a supportive Setting
- Ensure privacy, attend to client and patient comfort, minimize distractions, allow for time, sit down at the same level with the client and invite supportive individuals.
- Identify who should be present for the conversation.
“I am wondering if there are other persons who care about Max, who may want to take part in this discussion.”
- Take time to establish initial rapport with the client, using open-ended questions, compliments, and empathy statements.
“How is Max doing?” and “How are you doing?”
“I am glad that you brought Max in, so that we could address this problem.”
“The last 24 hours have been really tough.”
2. Understand the client’s Perspective
- Explore the client’s perspective about the pet’s illness, using open-ended questions.
“What are your concerns regarding Max’s condition?’
“What do you think is causing Max’s illness?”
“Tell me in your own words what you understand about Max’s cancer?”
- Determine the client’s desire for information. People have different ways of coping with bad news.
“Some clients like to know a lot about their animal’s illness and others prefer the basic facts. What would you prefer?”
3. Ask permission to proceed with information-giving (Invitation)
- Ask permission to share the information with the client.
“I am wondering if it is alright with you if I discuss some of the specifics regarding Max’s illness.”
4. Provide the explanation (Knowledge)
- Deliver the bad news in stages.
- Provide a warning shot.
“Mary, I have some news that may be upsetting for you to hear.” (Pause)
“Mary, I have some difficult information to share with you regarding Max’s condition.” (Pause)
- Give information in small easily understandable pieces. Share only 1-3 sentences at a time. Pause and check for understanding prior to proceeding.
“The cancer has spread to Max’s lungs. This will continue to make it very hard for Max to breathe and will eventually cause his death.” (Pause)
- Ask for the client’s permission to continue to disclose the details of the medical condition.
“Would you like me to tell you more about Max’s condition now?”
“This is a lot of information and we can talk about it in stages and take one step at a time.”
“Would you like to talk more when you can bring a friend with you?”
- Check for the client’s understanding, using open-ended questions.
“What questions does that leave you with?”
“What additional information may be helpful to you?”
“Tell me how you understand the choices for Max’s care.”
“What do you think are the most important points to present to your family?”
- Avoid use of technical jargon and define medical terms.
- Use supplemental tools, such as written materials or audio-recordings.
- Throughout the conversation acknowledge, validate and normalize the client’s emotional responses.
- Use silence, empathetic statements, and display compassionate and caring non-verbal cues (i.e. sit close to the client, caring facial expressions, gentle and calm tone of voice, slow pace of speech, leaning forward, and use of touch).
“I'm right here for you. Take your time.”
“I imagine how hard this is for you to talk about. This news is overwhelming.”
“This is a lot of information to absorb and it came unexpectedly.”
“It sounds like you are making decisions in Max’s best interest.”
6. Summarize, plan follow-up and offer support
- Summarize what has been discussed.
- Negotiate a plan for treatment or follow-up.
- Identify client support systems.
“I am wondering who else cares for Max and will support you in making decisions.”
- Provide information on support services (i.e. grief counseling and support groups).
Author: Jane R. Shaw, DVM, PhD, Assistant Professor, Argus Institute, College of Veterinary Medicine and Biomedical Sciences, Colorado State University
Offers a variety of resources to assist you in guiding your clients through the process of euthanasia and assist them in their grief.
Shaw JR, Lagoni L. End-of-life communication: Delivering bad news and Euthanasia-decision making. Vet Clin Small Anim 37:1; 95-108, 2007.