A lived forty-five minutes in a cancer-clinic room. You tell a patient a hard result using the six steps of the SPIKES protocol, choosing what to say at each step, and see in the room what each choice does: the seating, the pieces of news landing or piling up, the silence.
The brief it was built from
A role-play from the doctor's chair: telling a patient a result they did not want, in the six steps of a published bad-news protocol. The patient, a relative and a nurse speak in their own voices; the visitor chooses what to do or say at each step and the room answers. Three inputs change the conversation: who is with the patient, what she believes before she hears it, and how much she wants to be told. A clearly labelled scenario built on published teaching accounts of the protocol.
What is real, and what is a scenario
Real data
- The six steps of the SPIKES protocol (Setting, Perception, Invitation, Knowledge, Emotions, Strategy and summary), developed by Robert Buckman and Walter Baile, and the advice attached to each as taught in a published account: avoid hallway conversations, sit at the patient's eye level across the corner of the desk rather than over it, ask what the patient understands before telling, ask permission before giving details, give information in small chunks and check understanding, respond to emotion with empathic statements and silence, then present a plan, ask for feedback, summarise and invite questions
- The example empathic phrases and the 'So what happens now?' exchange come from that teaching account
- Its statement that nearly all patients want full information but remember that they were asked is reported here as that account's statement, not as a measurement made by this page
- From a 2015 commentary by one of the protocol's authors: more than 20,000 bad-news conversations may occur in an oncologist's career; a 2006 study of 729 medical oncologists found nearly half reported strong negative feelings such as sadness, guilt or stress; SPIKES is best viewed as a flexible guideline and has not been formally tested in clinical trials
Scenario & assumptions
- Anita, Priya and Rohan, the clinic, the afternoon, the result (a cancer that has spread to the bones) and every line anyone speaks are a labelled scenario. They are roles, not real people, and no real patient or clinician is portrayed
- How Anita and Priya react to each choice is written for the story from the teaching account's advice; a real patient may react quite differently, and nothing here predicts how a particular patient would
- The 'Her trust' and 'Taking it in' meters are illustrative: starting values (0.42 and 0.6) and the size of each change are invented and do not measure anything
- The 45 minutes in the room, the times on the clock, and the layout of the room are invented. The pieces of news that land on her lap or pile up on the floor are a visual metaphor
- Medical wording in the choices is simplified for a general audience and is not clinical advice or a template for a real conversation
- Which of the offered choices is 'as taught' follows the published account of the protocol; the protocol is a flexible guideline and good clinicians depart from it
- The full text of the original 2000 paper could not be read from the build environment (the publisher blocked automated access); the steps are taken from the secondary teaching account and the 2015 commentary, and the original is listed as the thing to read next
- Five minutes is the autoplay pace; making the choices takes longer
What you leave with
- Prepare the room before the words: privacy, no interruptions, eye level, and no desk between you
- Ask what the person understands before you tell them, and ask permission before you give details
- Give hard news as a warning and a few plain pieces with pauses, and answer the feeling before the facts
- End with a plan she helped shape, a summary, and a chance to ask questions
Sources
- SPIKES: A six-step protocol for delivering bad news: application to the patient with cancer (Baile, Buckman, Lenzi, Glober, Beale, Kudelka), The Oncologist 5(4):302-311, 2000 The original paper. Citation confirmed from search results; the full text was not readable from the build environment
- SPIKES, a Six-Point Protocol, Helps Physicians 'Break the Bad News' to Cancer Patients (CancerNetwork) The six steps, the advice for each, the example questions and empathic phrases, and the statement about patients wanting full information
- Commentary by Walter F. Baile accompanying Morgans and Schapira, 'Confronting Therapeutic Failure: A Conversation Guide', The Oncologist, 2015 (PMC4524764) The six steps named, SPIKES as a flexible guideline not formally tested in trials, over 20,000 conversations in a career, and the 729-oncologist survey
3D with three.js (MIT) · Narration voice: Kokoro-82M v1.0, voice af_heart (kokoro-onnx 0.6.1). Apache-2.0 (Kokoro-82M weights).
Events & moments
From request #2
Cost & efficiency
Original
Security & identity
Original