Which option best represents the body of knowledge for the Perception step in SPIKES when delivering bad news?

• A. Setting up interview
• B. Knowledge
• C. Strategy/Summary
• D. Perception

Answer: (C)

The Perception step is about uncovering what the patient currently thinks, understands, and believes about their illness. It’s the moment to explore their perspective, including what they know, what they fear, what they expect, and any misconceptions or information gaps. By asking open-ended questions like “What is your understanding of the diagnosis?” or “What concerns you most about this situation?” you map out the patient’s viewpoint. This helps tailor the rest of the conversation—what information to share, how to frame it, and how to address emotions—so the bad news is delivered in a way that fits the patient’s reality.

Setting up the interview focuses on logistics and environment, not the patient’s beliefs. Providing knowledge refers to delivering the actual information about the diagnosis and prognosis. Strategy and Summary deals with planning next steps and summarizing the plan after the discussion. Since Perception centers on the patient’s understanding and perspective, it’s the step that best aligns with the body of knowledge described.