ABSTRACT
This chapter considers all the patient's symptoms and all the information available to doctors and assesses the symptoms, signs and information given using this to choose the appropriate remedies for the problem, and offers extra information where available and appropriate. Giving a patient the news of a terminal illness, a poor prognosis, or telling them that they have cancer is never easy. It does not get any easier with time and experience. Avoid giving bad news and then immediately starting to talk in detail about 'treatment', as this just causes confusion. The term 'treatment' implies hope of a cure. A number of methods have been suggested for breaking bad news. One of these is the 'SPIKES' model suggested by Beale et al. This model uses a six-step approach: setting up the interview; patient's perception; invite the patient to discuss their situation with doctors; knowledge and information given to the patient; emotional assessment and summary and strategy.
