One of the most challenging parts of our job is preparing to deliver life-altering news to our pet parents.

Delivering a poor prognosis or having an end-of-life talk with pet parents is always a tough conversation, and no conversation is precisely the same.

 Each discussion needs to be approached with empathy, sensitivity, and clarity.

Having a framework that both you and your team can use when delivering tough news to pet parents can be helpful.

SPIKES – Six-Step Protocol for Delivering Bad News

When delivering news that may be shocking or upsetting to our clients, we want to be sure we can share in a clear, honest, and compassionate manner.

Baile and Buckman developed a framework to help health professionals convey the major talking points that should be addressed during these conversations.

SPIKES is a six-step framework that you and your team can use when having difficult conversations with your clients.

So, what does it mean?

SPIKES is a simple acronym to help you remember the framework:

• S- Setup

• P- Perception

• I- Invitation

• K- Knowledge

• E- Emotions

• S- Strategy and summary

Let’s dig in a little deeper…

Step 1: Setup

Setup the discussion in a private and comfortable location. Try to ensure it’s a space that will avoid interruption. If there’re more than one staff member who will be present, be sure you’re both clear on who will deliver the news.

Step 2: Perception

 First, try to understand the pet parent’s perception of their pet’s condition. It can be helpful to understand how serious things are from their perspective and can tell if perhaps they’re in denial.

To help start the conversation, you may ask something simple like, “What have you made of Charlie’s illness so far?”

During this part of the discussion, you can pick up on verbal and non-verbal cues to help you gauge their feelings about the situation. 

Step 3: Invitation 

During this step, we want to respect what our clients are emotionally ready to hear. This step can help you form your delivery.

You might ask, “At what level do you want to know about Charlie’s prognosis.”

This is by no means a way to withhold facts about a patient’s condition or illness, but rather, it may help you understand whether the client is looking for a “straight to the point” answer or if they’d like more detail to better understand the situation.

Step 4: Knowledge

Consider this the “meat and potatoes” of the conversation.

During this step, we want to share:

• Diagnosis

• Treatment Plan (if applicable)

• Prognosis

• How we can support

When possible, share client handouts or written details about the diagnosis, treatment plan, and prognosis. This can help the client digest what’s being shared and make a more informed decision about the next steps.

Step 5: Emotions

 These conversations are always challenging. Try to assess your client’s emotions during your discussion.

• Acknowledge any shock and ask them how they’re feeling.

• Their response may range from silence, distress, denial, or anger.

• If you’re unsure how to respond, try to respond empathetically. Allow some silence to let things sink in.

• Avoid arguing or getting defensive. Do your best to create a space that allows the pet parent to express their emotions without criticism.

Step 6: Strategy and Summary

To wrap things up, summarize what’s been discussed so far and clarify the next steps.  

• Pet parents will likely look to you to help make sense of the news.

• Explain what will happen next and what they can expect.

After the Conversation

After the conversation and your client has left, would you like a moment to yourself before seeing your next patient?

If taking a break at that moment doesn't work, you should plan for when you can find some breathing space within the next hour.

Suppose you’ve been following along with our recent series of articles. In that case, you know the demanding nature of the veterinary field can lead to high-stress levels and burnout among veterinary teams.

Be sure to prioritize your needs and well-being during high stress.

Take breaks, practice mindfulness, and engage in activities outside of work that make you feel recharged and refocused.

Remember, you’re not alone. Lean on your team for support and contact a professional who can offer tailored and personalized support.