SPIKES is a communication protocol used in delivering bad news. Which option lists the full steps in order?

SPIKES is a communication protocol used in delivering bad news. Which option lists the full steps in order?

• A. S: Setting up, P: Perception, I: Invitation, K: Knowledge, E: Empathy, S: Strategy and Summary
• B. S: Setting up, P: Perception, I: Invitation, K: Knowledge, E: Empathy, S: Summary
• C. S: Setting, P: Perception, I: Invitation, K: Knowledge, E: Empathy, S: Strategy and Summary
• D. S: Setting up, P: Perception, I: Invitation, K: Knowledge, E: Empathy, S: Strategy

Answer: (A)

Delivering bad news effectively rests on a structured approach that guides the conversation with care and clarity. The sequence starts by creating a proper setting—privacy, be calm, involve the right people, and establish a respectful space—so the patient feels safe to engage. Next, you assess the patient’s Perception to understand what they already think or know about the situation, which helps tailor the conversation to their level of awareness. Then you explore their Invitation: check how much detail they want and need, respecting their preferences and readiness to receive information. Knowledge follows in manageable portions, with information shared in plain language and at a pace the patient can absorb. This step is where you present the diagnosis or bad news, avoid medical jargon, and pause to check understanding. Emotions are expected and acknowledged through Empathy—responding to grief, anger, or confusion with supportive, validating statements rather than rushing to fix the situation. Finally, Strategy and Summary lay out the next steps, plan, and resources, and recap what has been decided so the patient knows what to expect going forward. Because the final step combines planning with a concise recap, the full, correct sequence is Setting up, Perception, Invitation, Knowledge, Empathy, Strategy and Summary. Other options either miss part of a step, mislabel the first stage, or separate the final components in a way that doesn’t reflect the established six-step flow.

Delivering bad news effectively rests on a structured approach that guides the conversation with care and clarity. The sequence starts by creating a proper setting—privacy, be calm, involve the right people, and establish a respectful space—so the patient feels safe to engage. Next, you assess the patient’s Perception to understand what they already think or know about the situation, which helps tailor the conversation to their level of awareness. Then you explore their Invitation: check how much detail they want and need, respecting their preferences and readiness to receive information.

Knowledge follows in manageable portions, with information shared in plain language and at a pace the patient can absorb. This step is where you present the diagnosis or bad news, avoid medical jargon, and pause to check understanding. Emotions are expected and acknowledged through Empathy—responding to grief, anger, or confusion with supportive, validating statements rather than rushing to fix the situation. Finally, Strategy and Summary lay out the next steps, plan, and resources, and recap what has been decided so the patient knows what to expect going forward.

Because the final step combines planning with a concise recap, the full, correct sequence is Setting up, Perception, Invitation, Knowledge, Empathy, Strategy and Summary. Other options either miss part of a step, mislabel the first stage, or separate the final components in a way that doesn’t reflect the established six-step flow.