Att ge svåra besked

Öva på att lämna allvarliga, livsavgörande besked med SPIKES och bemöta känslor med NURSE.

Det här övar du

• Deliver serious, life-changing news clearly and humanely using the six steps of SPIKES.
• Find out what the patient already understands, and how much they want to know, before giving information.
• Give a warning shot and a short, plain-language headline, then pause and let the news land.
• Respond to strong emotion with NURSE before moving on to information or plans.
• Summarise, agree on concrete next steps, and check understanding without false reassurance.

Dem du kan möta

• Birgitta, 61 — Recently retired teacher who has come in alone to hear test results for a cough, tiredness, and weight loss. She is hoping it is a stubborn infection and does not yet know she has cancer.
• Karin, 48 — Recently divorced bookkeeper with long-standing health anxiety who has come in alone to hear results for a breast lump. She is convinced it is "just her anxiety playing tricks" and is bracing to be told, once again, that she is overreacting. She does not yet know she has cancer.
• Göran, 56 — A civil engineer who has come with his wife Annika to hear biopsy results after blood in his urine and a cystoscopy. He receives the news with unnerving calm — "I understand. What is the next step?" — while Annika is visibly distraught. The challenge is recognising that his composure is a wall, not strength, and helping him make contact with what he feels before rushing to plans.
• Annika, 54 — Göran's wife. She has barely slept since the cystoscopy. She carries the fear he refuses to feel — tearful, searching, reaching for him. She is not hysterical; she is a normal person terrified for her husband.

Det här tittar återkopplingen på

• Setting up
• Assessing perception
• Obtaining invitation
• Giving knowledge
• Addressing emotions (NURSE)
• Strategy & summary
• Overall communication

Skattat mot: Dimensions follow the six-step SPIKES protocol (Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. "SPIKES — A Six-Step Protocol for Delivering Bad News: Application to the Patient with Cancer." The Oncologist 2000;5:302-311) and the NURSE empathic responses (Back AL, Arnold RM, Baile WF, Tulsky JA; VitalTalk). The anchor wording here is PsychBase's own, adapted with citation — nothing is reproduced from either source, and neither author nor publisher endorses or certifies this tool. Scores are generated by an AI reviewer from the session transcript. They are a practice aid, not a validated assessment: SPIKES and NURSE assume a trained human observer, and an AI score is not equivalent to one. Scores never gate progression.

Labbet är avsett för klinisk träning. Patienten genereras av en AI-språkmodell utifrån ett skrivet fall; inga verkliga patienter och inga patientuppgifter förekommer. Alla kan bläddra fritt; för att starta en session krävs ett kostnadsfritt konto.