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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.