FaMCAT: Criteria for Yes/No/NA: Criteria for Yes/No/NA
SPIKES
(S) Setting:
Meeting preparation	Communicated with others caring for patient before meeting, negotiate roles, reached consensus on information, i.e. prognosis/treatment, identify decision-maker(s)
Prepared room	Assures comfort, appropriate setting, allows for interpersonal space, provides tissues and/or water If made effort, then yes/no: if no effort, then N/A
Body language	Sat down, eye contact, open posture, demonstrates being engaged
Greeting	Makes appropriate introductions, explains role (as palliative care fellow or geriatrics fellow)
(P) Perception:	Asked what the patient/family already knew/assessed patient’s/family’s understanding
(I) Invitation:	Asked what the patient/family wants to know N/A if patient asks for information
	Gave a “warning shot” to indicate bad news will be given or to address concerns about what happened in the past
(K) Knowledge:	Gave information (in balanced manner, clarified misconceptions or misunderstandings) about current medical condition
	Avoided use of medical jargon
(E) Empathic Response:	Responded to emotions
	Wish statements for unrealistic treatment goals
(S) Strategy:	Check-in before moving on
	Checked for understanding
Summary	Provided summary at end of meeting, assessed understanding
Plan	Created follow-up plan, gave business card, arranged for next meeting
OTHER SKILLS:
Used empathic continuers	Statements that directly address patients’ emotions, validate their feelings, and invite further disclosure; used at least one nurse statement [(N)ame, (U)nderstand, (R)espect, (S)upport, (E)xplore]
Used empathic terminators	Statements that avoid the emotion or change the topic, or not respond to cues with expressions of empathy
Used Ask-Tell-Ask	Evaluating quality of ask-tell-ask, not quantity
Discussed Prognosis	Assessed desire for prognosis/life expectancy, delivered as range
Use of silence	Allowed patients and/or family members to respond to questions, nods head/verbal cues, appreciates and allows for silences/paused
Used open-ended questions	For example, “tell me about your loved one…”
Goal setting	Attempted to elicit patient’s or family member’s goals and expectations in context of ongoing or future care
Made a treatment recommendation	Tailored treatments to elicited patient’s goals/values as appropriate—i.e. chemotherapy, CPR, treatment alternatives, artificial hydration/nutrition, or hospice care
Spiritual and existential concerns	Assessed spiritual and existential concerns, offered chaplaincy
Patient’s/Family’s cultural background	Assessed patient’s cultural background and concerns
Explored patient identity/family support	Explored patient identity, asked patient/family about personal support
Mediated conflicts and anger	Among patient, family or interdisciplinary team, addressed medical errors
Discussed the 5 things	I love you, I forgive you, Please forgive me, Thank you, Goodbye
Discussed what to expect in the dying process	Explained what would happen if withdraw specific treatment, gave information about dying process
Managed time	Managed time effectively, balanced time constraints with needs of patient/family
Used appropriate level of directiveness	Guided conversation with patient and family
Leadership	Ran meeting appropriately, engaged other members of interdisciplinary team/consultants