Setting Up the Discussion
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
Discussion: Setting Up the Discussion
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i find this hard due to lack of available private spaces to have difficult conversations
need to become comfortable in these difficult conversations
can be uncomfortable better to practice and get a rapport
so healpfull for every patient
Yes, the ED physician will many opportunities to employ these principles. We are often the first doctors who will need to make time tom have this conversation generally out of necessasity
I am giving this to the physicians.
interesting.. just got to know about spike
Good to know.
Good to know
nice way to remember
I use spikes regularly.
spikes help ensure everything is addressed
the more you practice the better you will get. palliative care rotation may be helpful
Buen recurso nemotecnico para no olvidar como planificar la discusión
SPIKES is helpful
interesting.. just got to know about spikes
I’ve found spikes to be a very helpful mnemonic.
Very difficult topic for many
Physicians and nurses need to have these discussions with patients and their care givers. Yes DNR needs to be addressed. But also the stages of life and death, with dying must be dealt with. Care needed before the end comes.
the more you practice, the better. helpful to do a pall care rotation