S – Setting

• Arrange for some privacy
• Involve significant others
• Sit down
• Make connection and establish rapport with the patient
• Manage time constraints and interruptions.

P – Perception of condition/seriousness

• Determine what the patient knows about the medical condition or what he suspects.
• Listen to the patient’s level of comprehension
• Accept denial but do not confront at this stage.

I – Invitation from the patient to give information

• Ask patient if s/he wishes to know the details of the medical condition and/or treatment
• Accept patient’s right not to know
• Offer to answer questions later if s/he wishes.

K – Knowledge: giving medical facts

• Use language intelligible to patient
• Consider educational level, socio-cultural background, current emotional state
• Give information in small chunks  Check whether the patient understood what you said  Respond to the patient’s reactions as they occur
• Give any positive aspects first e.g.: Cancer has not spread to lymph nodes, highly responsive to therapy, treatment available locally etc.
• Give facts accurately about treatment options, prognosis, costs etc.

E - Explore emotions and sympathize

• Prepare to give an empathetic response:
• Identify emotion expressed by the patient (sadness, silence, shock etc.)
• Identify cause/source of emotion
• Give the patient time express his or her feelings, then respond in a way that demonstrates you have recognized connection between 1 and 2.

S – Strategy and summary

• Close the interview
• Ask whether they want to clarify something else
• Offer agenda for the next meeting eg: I will speak to you again when we have the opinion of cancer specialist.

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