Breaking Bad News

Definition :
Bad news any information which
adversely and seriously affects an
individuals view of his/her future
Buckman R. Breaking Bad News : A Guide for Health Care Professionals. Baltimore : Johns Hopkins University
Press , 1992:15
 Importance???
Doctor
Frequent but stressful task
Ethical and legal imperatives
Patient
Patients expectation
Clinical outcomes
 Challenges
Amount of information disclosed to patient
Patients emotion
Right amount of time
 6-STEP STRATEGY
S SETTING
P PERCEPTION
I INVITATION
K KNOWLEDGE
E EMOTION
S - SUMMARY
 SPIKES
First of all ..Get The Facts
Privacy
Involvement of Significant Others
Sit Down
Make Connection
Manage Time Constraints/Interruptions
 SPIKES
Open-ended questions
Understanding
Illness denial
Unrealistic Expectation of Treatments
 SPIKES
Desire For Amount of Information About
Illness
How would you like me to give the
information about the test results?
Would you like me to give you all the
information or sketch out the results and
spend more time discussing the treatment
plan?
 K
SPI ES
Disclose Information
Warning
Vocabulary
Chunks & Check
Content : Diagnosis , Details , Prognosis ,
Treatment Options
 SPIKES
Patients Emotion/Concern
Empathetic Response
1)Observe & identify emotion
2) Identify reason for emotion
3) Connect the emotion with reason

Doctor : Im sorry to say that the X-ray shows that the

chemotherapy doesnt seem to be working. [pause]
Unfortunately , the tumour has grown somewhat.
Patient: Ive been afraid of this! [cries]
Doctor : [Move his chair closer , offers tissues]. I know that this
isnt what you wanted to hear. I wish the news were better.
 SPIKES
Summarize & Plan
Ask For Further Questions
Offer Further Follow Up For Discussion
 Last But Not Least.
Documentation
Persons
Actual Diagnostic Words
Actual Prognostic Words
Treatment intent (Curative / Palliative)
Response of patient and supporter
Understanding by patient
Treatment plan
 References
Walter FB , Robert B , Renato L , Gary G , Estela AB , Andrzej
PK et al. SPIKES-A Six-Step Protocol for Delivering Bad News:
Application to Patient with Cancer. The Oncologist
2000;5:302-311
Mid Essex Hospital Services : Breaking Bad News Clinical
Guideline 2014
http://patient.info/doctor/breaking-bad-news