Breaking Bad News

Someone is gonna die and we cant do anything further
Someone is dead
Someone has been diagnosed with a very grave diagnosis

These 3 scenarios are very common is the MCEM Part C OSCEs as well as in real life in the ED. Mastering the skill to break any bad news comes with practise, and not necessarily will be received or accepted by the next of kin in the same way in different cultures. But the proforma for breaking any bad news has been standardized in most of the developed countries and can easily be applied in our day to day operations in the ED and in the MCEM Examinations. While researching various protocols from different settings, the one listed below was found to be much easier to remember for practice and exam settings.
It is called as SPIKES Protocol.

Settings
Perception
Invitation
Knowledge sharing
Empathy
Summarize or strategy formulation

Settings:

Hi, My name is Dr. XYZ, I am one of the ED Registrars caring for Mr. ABC. May I know how you are related to Mr. ABC.
I am his daughter, Ms. PQRS
I need to discuss something privately, we can sit in this room. Here is my Nurse Ms. EFG who will be with us. I have given my mobile phone and pager to one of my colleagues so that we wont get disturbed in our conversation.

Perception:

How is my father? I want to see him....
I am here to talk about your father. What do you know about his condition till now? or what has been told to you until now?

............................................................................. TO BE CONTINUED