Table 1.

Summary of SPIKES comprised of six steps

S (Setting up the Interview)	Arrange for some privacy Attendance of the family
P (Assessing the patient’s Perception)	Correction of wrong perceptions Questions that can be answered freely
I (Obtaining the patient’s Invitation)	Confirmation of the information that the patient demands Confirmation of what a patient thinks he/she wants to know
K (Giving Knowledge and information to the patient)	Try to use nontechnical words Periodically check the patient’s understanding
E (Addressing the patient’s Emotions with empathic response)	Let the patient know that you understand the emotion Attitude to understand the emotion of the patient
S (Strategy and summary)	Put together information to be provided and confirm it for the last time Set an aim that is achievable in the future