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Cancer Health Center

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Communication in Cancer Care (PDQ®): Supportive care - Health Professional Information [NCI] - Communication Along the Disease Trajectory


The SPIKES method is useful because it is short, is easily understandable, and focuses on specific skills that can be practiced. Moreover, this protocol can be applied to most situations of breaking bad news, including diagnosis, recurrence, transition to palliative care, and even error disclosure. This method also includes reflective suggestions for physicians on how to deal with their own distress in being the messenger of bad news. In an innovative qualitative study focused on communicating bad news related to cancer recurrence,[20] patients with diagnoses of gastrointestinal cancers during the previous 2 years listened to audio recordings of oncologists using the SPIKES approach (with standardized actors) and then identified what they liked and disliked about the communications. Three major themes were identified:

  • Recognition, which involved the physician acknowledging or reflecting the patient's emotional response, without becoming overly emotional or offering platitudes.
  • Guidance, which referred to the physician remaining in charge of the dialogue, pointing out the patient's strengths, and offering positive recommendations.
  • Responsiveness, which involved the physician moving back and forth between providing "recognition" and providing "guidance," using an interacting, rather than lecturing, style.

Patients consistently noted that they did not like the physician beginning the communication of bad news with words such as "unfortunately."

Whereas most physicians in Western countries tell their patients that they have cancer, information about prognosis is less commonly presented. Most cancer patients report that prognostic information is of great importance to them. If patients are actively encouraged to ask questions, prognosis is the one area in which they desire information and actually increase their question-asking.[21] In one study,[22][Level of evidence: II] prognostic information that was rated as most important by women with early-stage breast cancer included knowing the probability of cure, disease stage, and chance of curative treatment and receiving 10-year survival figures comparing receipt and nonreceipt of adjuvant therapy. Probability of cure and knowledge of disease stage were also identified as high-priority needs in another study of women with early-stage breast cancer.[23][Level of evidence: II] However, patients clearly vary in their desire for prognostic information, and patients with more advanced cancer may be less inclined to receive information about their life expectancy;[24] many others may be ambivalent. It has also been shown that physicians and their patients who have advanced cancers often overestimate the probability of survival.[11] Thus, there is considerable controversy about how to discuss prognosis with patients; a number of articles have made valuable suggestions.[24,25,26,27,28]

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