Applying the SPIKES Method in Eye Care

Jay Lytle, OD, FAAO

They say that breaking bad news is giving someone any information that changes their outlook of the future in a negative way. And when we think about breaking bad news, we think of other areas of medicine, conditions with high mortality rates like pancreatic cancer or ALS or conditions with high morbidity rates like diabetes or multiple sclerosis.

But we have our fair share of bad news in the eye care field. Dr. Walter Baile from the MD Anderson Cancer Center in Houston, Texas designed this six step approach called the SPIKES method.

The S stands for setting up the discussion, and so you’re preparing yourself but you’re also creating a quiet, comfortable private environment to discuss with the patient their news. You allow them to have support members present, you sit down and you have no barriers between you and the patient.

The P stands for perception and that’s where you figure out what a patient knows about their medical situation.

The I is invitation, where you get their permission to move forward. You might say, is this a good time to go over your results?

The K stands for knowledge, and that’s where you actually give them the bad news. And you first foreshadow it, you might say, I’m sorry, I wish I had better news. And then in a direct, compassionate and understandable way, you give them the news and in their own health literacy level.

The E is empathy. And that’s where you identify the patient’s emotions during the discussion, you explore the reasons for those emotions, and then you validate those emotions.

And then the S is summarizing. And you review what you’ve told them, and then you help establish a mutually agreeable treatment plan. And research shows that when you use these six steps, it really helps someone process the bad news better.

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