ICE: Ideas, Concerns, Expectations
When to use it
Role-plays involving someone reluctant, refusing, confused or demanding — a patient who won't take medication, a parent wanting antibiotics, a friend who won't seek help. Also useful in any consultation-style station.
The steps
- 1
Open and listen
Start with an open question and let them talk without interrupting for the first minute.
- 2
Ideas
'What do you think might be causing this?' / 'What have you heard about this medicine?'
- 3
Concerns
'Is there anything in particular that's worrying you about it?' — often the real barrier is here.
- 4
Expectations
'What were you hoping would happen today?' Clarify what is realistic.
- 5
Respond and share the decision
Address the specific concern with honest information, offer options, respect their choice if they have capacity, and agree a plan including a safety net.
Worked example
A patient has stopped taking blood-pressure tablets. Ideas: 'What made you decide to stop them?' — 'I feel fine, so I don't think I need them.' Concerns: 'Is anything worrying you about the tablets?' — 'My friend said they damage your kidneys.' Expectations: 'What would you like to happen?' — 'I'd rather manage it with diet.' Response: explain that high blood pressure usually has no symptoms, address the kidney worry honestly, welcome the diet plan as part of treatment, and agree a trial with a follow-up blood pressure check.
Try it yourself: Role-play: a patient has stopped taking their blood pressure tablets. Find out why and discuss it with them.
Common mistakes
- Lecturing before listening.
- Asking ICE questions as a checklist without responding to the answers.
- Treating a capable person's disagreement as something to overcome rather than understand.
- Forgetting to agree a plan and safety net.
Questions that use this framework
- Sell me this pen.Main frameworkStandard
- Parents of a one-year-old tell the practice nurse they do not want their child to have the MMR vaccine because they have read it can cause autism. How should this be handled?Main frameworkChallenging
- Role-play: a patient has stopped taking their blood pressure tablets. Find out why and discuss it with them.Main frameworkChallenging