This review is about how to break bad news in the emergency department. While this occurs in many areas of medicine, emergency medicine is unique in that the emergency department environment can be challenging and we generally do not have pre-existing relationships with our patients to draw upon.
Points to Focus upon
The SPIKES mnemonic is a common methodology used within the ED to break bad news.
- Setting: Private. Find a chair and sit down. Prevent interruptions. Bring support (e.g. social worker).
- Perception: Determine the patient or family member’s understanding of what is happening. Family members of ill/injured patients may or may not have received any information from others about what has happened.
- Invitation: Deliver the news and invite the patient to ask questions or provide guidance on the amount and timing of the information they would like to receive.
- Knowledge: Outline what has happened in an organized way using plain language. Know that they may recall little after you have delivered the news.
- Empathy: The patient/family may have expected (sadness) or unexpected (anger) reactions. Empathize with them.
- Summary: Summarize what has been discussed, what the next steps will be, and when/how they will receive additional information.
Recommended Reading, Videos, and Podcasts
- CanadiEM: Breaking Bad News in the ED
- Geeky Medics: Breaking Bad News (UK Resource)
- Buckman RA. Breaking bad news: the SPIKES strategy
This post was copyedited by Johnny Huang