10. Breaking Bad News

Question 1

What can the result of breaking bad news badly be?

Answer 1

Damaged doctor-patient relationship, damaged emotional well-being of the patient, difficulty adjusting to and coping with the illness.

Question 2

What is a good model for breaking bad news?

Answer 2

SPIKES - setting, perception, invitation, knowledge, empathy, strategy/summary.

Question 3

What is the S in SPIKES for delivering bad news?

Answer 3

Setting and listening skills. Ensure the patient is being told in a private, uninterrupted environment.

Question 4

What is the P in SPIKES for delivering bad news?

Answer 4

Patient’s perception. Check what the patient already knows before telling them.

Question 5

What is the I in SPIKES for delivering bad news?

Answer 5

Invitation from the patient to give information. Don’t overwhelm the patient with information, only tell them in a level of detail they are ready to hear.

Question 6

What is the K in SPIKES for delivering bad news?

Answer 6

Knowledge. Give them a warning shot that there will be bad news, e.g. “I’m so sorry to tell you”. Give information in small chunks and avoid jargon so they follow the conversation.

Question 7

What is the E in SPIKES for delivering bad news?

Answer 7

Empathy. Ask the patient how they are feeling and listen to their concerns.

Question 8

What is the S in SPIKES for delivering bad news?

Answer 8

Strategy and summary. Summarise the main discussion topic and check their understanding. Discuss the strategy and agree on the next step. Give closure to the discussion.