SKIPS: A Simple Modification of a Prior Simulation Tool for Difficult Patient Discussions

Patient communication during ethical or difficult treatment decisions is a complex interaction. We present our initial experience with a structured framework for discussion, SKIPS (setting, knowledge, invitation, perception and strategy), as a modification to a previously reported tool for breaking bad news, SPIKES. Our new framework emphasizes patient beliefs and wishes in the setting of a discussion requiring ethical considerations or treatment decisions. Initial evaluations of the SKIPS tool were favourable by resident and faculty, with faculty reporting a greater chance of utilizing SKIPS than the residents.