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Using the SPIKE protocol to relay a terminal diagnosis

The SPIKES protocol is becoming a standard for medical professionals such as doctors and nurse practitioners who have to deliver bad news, such as a terminal diagnosis of cancer, to patients.

SPIKES is an acronym for the following:

S: Set up the interview — Medical professionals should find a suitable place to meet with the patient.

P: Perception of the problem — Medical professionals should ask questions to understand how the patient views their condition.

I: Invitation for information — Get the patient’s invitation to deliver the news. Patients may need to prepare to receive bad information. Communication will

K: Knowledge and information — Advise the patient of their condition, in smaller chunks if necessary, making sure to tailor your communication to their level of understanding and using plain language.

E: Empathically respond to emotions — Talk with the patient about the emotional reaction they are having. It is important for patients to be able to process through their emotions and for the medical provider to demonstrate empathy before a patient will be able to move on to the final step.

S: Strategy and summary — Patients are able to handle a terminal diagnosis better if they have a plan for addressing it. Many will want to know how much time they have left and what their next steps are. 


Medical professionals who have studied and used the SPIKE protocol have found it to be beneficial when having these difficult conversations with patients. Patients also benefit as it gives them an opportunity to be involved in their treatment plan.

Tailoring communication to the immediate needs of terminally ill patients

Discussion of a terminal diagnosis is likely to involve multiple conversations with the patient. Physicians and nurses should be sensitive to the immediate needs of the patients at each conversation. This may include a discussion of a treatment plan, but may also involve guidance into obtaining support related services such as: 

• Counseling: The patient and the patient’s family may benefit from obtaining additional counseling services to help them process their terminal diagnosis and prepare for the future.

• Estate planning: Patients will likely need the services of an estate planner to ensure they pass as much of their estate onto their family as possible.

• Additional legal services: Patients diagnosed with mesothelioma and other asbestos-related cancers may not realize that they have the right to pursue damages. There is a fast-track court set up to help these individuals, but it is imperative they speak with a knowledgeable mesothelioma attorney as soon as possible.

Communication is a critical skill for medical professionals, especially for those practicing in the field of oncology or those who deliver palliative care. Advising patients on the full scope of their options empowers them to make important decisions about how they want to handle end of life matters.

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