Think about the best place to have the conversation, ideally somewhere quiet with minimal interruptions. Also consider who the patient may or may not want to have present for the discussion.
The Best Setting
The ED can be a challenging place to have sensitive conversations around difficult topics. Not only is private space limited in many settings, but physicians must establish trust and rapport with patients and families in a very short amount of time.
SPIKES is a six-step framework that is often cited as a tool to approach difficult conversations where physicians must deliver bad news to a patient. However, it may also be used for other clinical scenarios such as when discussing end of life issues. The following is a general approach for setting up the elements that help to facilitate difficult conversations:
SETTING UP the interview
Assessing the patient’s PERCEPTION
Obtaining the patient’s INVITATION
Giving KNOWLEDGE and information to the patient
Addressing the patient’s EMOTIONS with empathetic responses
STRATEGY and SUMMARY