Confronting Therapeutic Failure: A Conversation Guide

Abstract

We reflect on the impact of bad news on both clinician and patient in the setting of cancer treatment failure. We review the classic six-step SPIKES (setting, perception, invitation for information, knowledge, empathy, summarize and strategize) protocol for giving bad news that has been widely adopted since it was first published in this journal in 2005. The goal of such a conversation guide is to describe both the process and the tasks that constitute vital steps for clinicians and to comment on the emotional impact of the conversation on the clinician. Confrontingtherapeutic failure isthe hardest task foroncologists.We offer practical tips derived from a thorough review of the evidence and our clinical experience. The Oncologist 2015;20:946-951Implications for Practice: Discussing the failure of anticancer therapy remains a very difficult conversation for oncologists and their patients. In this article, the process of confronting this failure is broken down into various components, and practical tips are provided for clinicians following a classic protocol for breaking bad news. Also addressed are the emotions of the oncologist and the reasons why these conversations are typically so hard. These insights are based on solid research intended to deepen the therapeutic connection between physician and patient.

The use of protocol in breaking bad news: evidence and ethos

“…However, it has been identified that these strategies lack robust supporting evidence (Fallowfield and Jenkins, 2004). This article will focus on the SPIKES protocol developed by Baile et al (2000) due to the frequency to which it is referred to in guidance (National Council for Hospice and Palliative Care Services, 2003, RCN, 2013, Seifart et al, 2014, utilised in teaching programmes (Baer et al, 2008) and adopted by clinicians (Morgans and Schapira, 2015). The evidence base for this approach will be examined and the utility and ethos of step-wise protocols will be discussed with the intention of providing a fresh perspective on breaking bad news.…”

Confronting Oncologists’ Emotions

“…I was exceptionally pleased to read Morgans and Schapira's [1] paper, "Confronting Therapeutic Failure: A Conversation Guide," in The Oncologist.…”

“…In essence, although this research examined grief in response to patient loss, the subtext of these studies is looking at relationships and attachments to patients. To my knowledge, Morgans and Schapira [1] are some of the few clinicians to openly acknowledge the issue of attachment in the context of patient communication.…”

“…Morgans and Schapira's [1] paper can serve as a catalyst for all oncologists and health care professionals to begin addressing this tension between attachment to patients and the pain that comes when they die or suffer. As the authors suggest, the SPIKES (setting, perception, invitation for information, knowledge, empathy, summarize and strategize) model, a patientcentered communication protocol for delivering bad news, can be an effective strategy for oncologists to use when facing this emotional labor in their work.…”

Comunicação entre cuidadores familiares e pacientes oncológicos em cuidados paliativos: um estudo na perspectiva da Psicologia Analítica

“…Artigo recente (Morgans & Schapira, 2015) Cabe aqui destacar que os protocolos de comunicação cumprem uma função de orientar e divulgar informações sobre o manejo da comunicação em saúde para profissionais que precisam lidar com esta tarefa diariamente e nem sempre receberam treinamento adequado para tal. Eles se propõem sintetizar conhecimentos advindos de pesquisas diversas e apresentá-los de maneira estruturada, didática e em linguagem protocolar própria dos meios biomédicos (Baile et al, 2000).…”