Abstract

Breaking significant news is difficult. This is compounded when space to have these conversations is limited. This was the issue raised by the Care Quality Commission at the last hospital inspection. With an interest in communication skills, I was asked as a member of the Hospital Palliative Care Team for some advice; what guidance should we follow to break significant news, so that even if we do find ourselves, literally in a tight corner, we can try and do our best.

The acronym SPACE was developed, space being the problem and in part, the solution.

Setting

Preparation

Ask, Active listening, Acknowledge feelings

Chunk and Check

Exit well

The letters represent principles of good communication that are based on well-researched, established models. The aim with SPACE is for it to be a simple, memorable acronym that will encourage and enable all in better communication. A successful outcome would be staff feeling more confident in breaking significant news and subsequently a better experience for patients and relatives. This model is currently being incorporated in to communication skills training in the hospital and in the hospice. We are also teaching bespoke groups. In conjunction with the hospice’s graphic designer, SPACE cards have been developed that fit in to the ID badge holders, so staff can carry these as an aide-memoir. We have also developed a two minute promotional video, illustrating its purpose. The Hospital Research, Development and Innovation Team have also been supporting its development. The Chief Hospital Nurse is excited about its simplicity and potential impact across the Trust. Its effectiveness is currently being evaluated. Interestingly, our Head of Human Resources at the hospice is interested in using it as a model to assist managers in having challenging conversations with staff. SPACE is for all, there is always room for improvement, however experienced we are.