Which component is included in the SPIKES framework for delivering bad news?

• A. The patient’s family should decide the pace of disclosure.
• B. Ethical and legal constraints override patient involvement.
• C. SPIKES components include: setting up the interview, assessing perception, obtaining invitation, giving knowledge, addressing emotions, and strategy/summary.
• D. Delivery should be brief and simply stated.

Answer: (C)

Delivering bad news with care follows a structured approach called SPIKES. It starts by setting up the interview to create a private, supportive environment, then checks the patient’s perception of the situation, and gauges how much they want to know (invitation). Next comes giving knowledge in a clear, honest, and appropriately paced way, followed by addressing the patient’s emotions with empathic responses. Finally, it outlines a plan—strategy and a concise summary of next steps. This combination—setting, perception, invitation, knowledge, emotions, and strategy/summary—is exactly what the correct choice lists.

The other options don’t fit this framework. Letting the family decide the pace undermines patient autonomy. Treating ethical and legal constraints as overriding patient involvement contradicts the patient-centered focus of SPIKES. Saying news should be brief and simply stated ignores the tailored, empathetic, and stepwise approach SPIKES advocates.