SPIKES for Difficult Conversations with Cancer Patients

Author: Harold J. Burstein MD, PhD
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A hallmark of oncology practice is the need to share bad news with patients. Too often cancer is a devastating disease, and oncologists must by necessity discuss heart-breaking and frightening clinical results with patients and their families. Training in oncology often focuses on technical performance of care delivery—the right type of surgery, how to arrange radiation treatment fields, chemotherapy dosing, and side effect management. Oncology training usually does not concentrate on a different kind of professional performance: the communication of medical information. The resulting inexperience may be compounded by the stress of bad news, for both the clinician and the patient. Seasoned clinicians may develop successful ways to talk with patients, but that often occurs through years of experiences, both good and bad.Fortunately, the literature on how to better manage these moments with patients, families, and medical providers is growing, yielding better communication and a more satisfying emotional experience. In this issue of JNCCN, we feature an article by Jacobsen and Jackson that outlines a communication approach for oncologists when discussing some of the most challenging topics in cancer care: “bad news” and care at the end of life. These are some of the most demanding moments in the lives of cancer providers, and suggestions that enhance our ability to communicate with our patients are most welcome.Guidance for such important clinical moments is clearly needed, and SPIKES is an acronym that is worth remembering in this context: S, setting up the interview; P, perceptions of the patient; I,...

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Harold J. Burstein, MD, PhD, editor-in-chief of JNCCN, is an Associate Professor of Medicine at Harvard Medical School and a medical oncologist at Dana-Farber Cancer Institute and Brigham & Women's Hospital. He is a clinician and clinical investigator specializing in breast cancer.

Dr. Burstein attended Harvard College and earned his MD at Harvard Medical School, where he also earned a PhD in immunology. He trained in internal medicine at Massachusetts General Hospital and was a fellow in medical oncology at Dana-Farber before joining the staff.

Dr. Burstein's clinical research interests include novel treatments for early- and advanced-stage breast cancer and studies of quality of life and health behavior among women with breast cancer. He has written widely on breast cancer in both traditional medical journals and on the web, including New England Journal of Medicine and Journal of Clinical Oncology. International committees focusing on cancer treatments that he has or continues to participate in include the NCCN Clinical Practice Guidelines Breast Cancer Panel, St. Gallen Breast Cancer Panel, CALGB Breast Cancer Committee, ASCO Health Services Research and Clinical Research Committees, the National Quality Forum Breast Cancer Technical Panel, and other ASCO expert panels.

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