Knowledge and Information – How to Break News

00:00 And then there's the K in SPIKES, knowledge.

00:05 So actually giving the information to the patient.

00:08 Because these are often going to be emotionally laden, it's best that you give a warning shot.

00:14 So the way that you convey the news is going to help prepare them for what you're going to tell them.

00:21 So that when warning shot is something like, "Unfortunately, I've got some bad news to tell you, or I'm sorry to tell you that..." and then you give the news.

00:32 So, some opening sentence that says here, you know, here's something coming.

00:37 You have to prepare yourself for the shock.

00:39 And then I'm going to give you the news.

00:44 So, the information, the knowledge that you give should be at the patient's level of understanding.

00:50 Again, you should not rely on the medical jargon.

00:52 You should try to use basic language that the patient can appreciate.

00:57 It's best to do it in a headline. So, if you think about a newspaper, how they put the top headline, and then they have the text under it, you give the headline as the first amount of information.

01:11 So, after you've given the warning shot, it's a succinct summary, focused on the bottom line of what the news is.

01:18 So, I'm sorry to tell you that you have cancer.

01:21 And then the best thing to do at that point is just to stop, pause, be silent. And let that news sink in.

01:29 Again, it's best to avoid any kind of medical jargon, technical terms, euphemisms.

01:35 Try to be as clear as possible in that headline.

01:41 It's also important that you avoid excessive bluntness.

01:43 So even though you want it to keep it short and straightforward, you don't want it to be blunt.

01:50 If it's too harsh, the patient may blame the messenger.

01:55 So for instance, you're meeting a loved one, in an emergency room, their family member has died.

02:03 The patient has died in a car accident.

02:05 You know, just saying your family members dead.

02:10 You're too blunt, and they haven't gotten any time to sort of prepare for that news.

02:16 Or you're talking to a patient that's been in a car accident, and now they're going to be paralyzed.

02:21 So, you know, saying you're never going to function normally again.

02:25 If that's too blunt of saying it that way, you really got to ease into it.

02:30 Make sure it's clear what the information is, but not so blunt, that the patient gets upset just from the news itself.

02:36 As I've talked about giving information in small chunks, so even though there might be pieces of information.

02:41 So it's a cancer that might have spread to another area.

02:48 It's best to start just with, you have cancer, and then give the other information about metastasis in a second chunk, second chunk after the fact after the patient's had a reaction to the initial part of the information.

03:04 I think it when we're talking about active listening, being silent after you've given the news, waiting for the patient's response, that's the best strategy.

03:13 Waiting for them to say something given emotional reaction.

03:17 That's what you need to do is just however long that is giving that pause after you give him the headline.