Support for Healthcare Professionals to have “Difficult Conversations” with Teenage and Young Adult Cancer Patients

Initiating difficult conversations and breaking bad news can be extremely stressful and challenging for healthcare professionals.

There are several frameworks available that can aid the structure of these conversation. They should only provide a guide to conversation and should not be used as a checklist.

One such example is SPIKES:

Setting – the physical setting for breaking bad news needs to be quiet, comfortable and a place where you are unlikely to be disturbed. Setting aside time and turning off phones and other distracting noises can also help.

Perception – it is important to check what the patient’s understanding is so far and what they are expecting

Invitation – you should ask how much information the patient wants, let the patient know they can pause or stop the consultation at any point and that they can ask any questions.

Knowledge – leading on from Invitation, delivering the information and results, as well as providing a plan of care, is also key. Checking the patients notes and results, ensuring you are fully updated prior to the consultation, is again important.

Emotions and Empathetic Response – you should acknowledge how the patient may be feeling, such as upset and in shock. Allow silences for the patient to gather their thoughts

Strategy and Summary – to help the patient understand, you should summarise the information given and the plan, providing information of next steps and follow ups. Providing written information, safety netting advice, and contact details is also useful.

There are many resources available to help to support healthcare professionals having difficult conversations. The following may be useful: