The following is a summary of the workshop

Learning objectives of the Breaking Bad News Workshop at NMUH

Develop an approach to breaking bad news

  • encouraging an individual response unique to the needs of each patient

Provide strategies

  • to help the patient identify and address those complex feelings, concerns, and fears created by bad news

Develop skills

  • in developing a plan that covers common ground
  • which incorporates clinical realities with the values of the patient

Use time effectively

  • to lead to a better understanding and improved patient care.

Increase confidence

  • in the ability to disclose unfavorable medical information to patients

Identify approaches which work well and gain awareness of some of the difficulties .

Review SPIKES and other systems for breaking bad news



In groups of two or three the following were discussed as an icebreaker

Q1. How do you feel about your own ability to break bad news?

Q2. Give examples of what Bad News you have seen or those you would include in the healthcare context. (include bad examples!)

Students were split into groups of three with role playing of a doctor, a relative and an observer with a scenario that the patient and relative had to discuss in 10 minutes. Following this the doctors relative and observers snowballed together for 5 minutes and fed back to the group.


“any information which adversely and seriously affects an individual’s view of his or her future”    Rob Buckman (1992).


S    Setting up an interview

P    Assessing patient’s perception

I     Obtaining the patients invitation

K    Giving knowledge

E    Addressing the patients emotions with empathetic response

S    Strategy and summary



 B – Background,

R-  Rapport,

E – Explore,

A – Announce

K –  Kindling

S – Summarize



A  – Advanced preparation

B  – Build a therapeutic relationship

C  – Communicate well

D  – Deal with patient and family reaction

E  –  Encourage and validate reaction

(all references below)

Common features of all

1.Be prepared

  • Read and understand the results
  • Talk to the clinician
    • performing the procedure
    • Or later involved with the case
  • Anticipate questions
    • “Are you certain”
    • “Might there be a mistake”
  • Find the answers


  1. Forecasting and delivering bad news
  • What is the patients level of understanding
  • Forecasting
    • “I am afraid I have some bad news to share with you”
  • Delivering bad news
    • .Clarity by you will allow a realistic response from the patient
    • Be clear, brief with no jargon, no abbreviations
    • Avoid jargon that hides the truth.
    • Deliver if you can diagnosis and treatment.

3.Emotions, perspectives, agenda and the readiness to proceed of the patient

  • Silence
    • Non verbal communication
  • Acknowledge anticipated feelings
    • “I suspect that has been difficult to hear
    • “people often have strong feelings at times like this but not every patients feeling are the same. What are you experiencing?
  • Provide direction
    • “Before I tell you about this condition and this treatment I would like to pause and hear about you initial reaction to the news”
  • Use active listening
  • Elicit the patient’s experience and perspective
  • Determine the preference of how to proceed
    • Is there a readiness to proceed.
    • What additional information is needed
    • Who else should be present
    • What level of detail is required
  1. Delivering Detail
  • Establishing the agenda
  • Ask – tell – Ask
    • Ask what the patient knows
    • Tell the patient the details of the condition
    • Ask about what they understand of what has been shared


  • Address the patient’s initial feelings, ideas and expectations amd their preferences of how to proceed
  • Plan how ,when, where, and who
  • Forecast bad news
  • Short simple clear statements including what is bad
  • Determine what the patient knows or experienced before discussing the details of treatment

Reflect on all these points in your own time and ask yourself the following questions

  • What do I think this learning was about?
  • How can I apply it to my work ?
  • What barriers may there be for me and others ?
  • How will I manage these barriers ?
  • How will I know if I am doing things better ?

I recommend the on line BMJ e-learning Communication Skills

eBMJ Communication Skills

After completing and submitting a short reflection on one or more of these modules the certificate can be saved as a pdf file and upload to you NHS e-portfolio

References and sources including links


Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. SPIKES – A Six-Step Protocol for Delivering Bad News: Application to the Patient with Cancer.

The Oncologist 2000;5:302-311



Daily Telegraph article

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