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SPIKES Summary table

Page history last edited by lesley.hamilton@gmail.com 10 years, 11 months ago

SPIKES Protocol for Breaking Bad News

(Buckman, 2005)

(Baile et al., 2000)






In-person rather than on phone

Cell phone off; TV & other distracters off; prevent interruptions

Involve significant others – cultural – all family members - family and patient acceptance of setting

Sit down – avoid barriers like a desk – easier for eye contact, less looming, authoritative (bad news by mistakes, expensive of health/life, prison settings – be careful for self)

Look attentive, calm – “psychotherapy neutral position, ” eye contact (although if tears, break eye contact momentarily)

Listening mode – silence (silence is golden, to let patient and family assimilate the news and the experience, silence to hear what patient has to say, time to process and develop questions) and repetition of words used

Cultural considerations



“Before you tell, ask” – find out what the patient’s belief or expectations are

Take in cues of body-language and words used

Do not confront a patient in denial on first discussion



Overt ask  - patient right to know AND patient right to not know

How much do they want to know?



Use warning words that bad news is coming – give a few seconds of preparation

Use patient’s words as much as possible and avoid technical jargon (growth versus neoplasm)

Technical jargon difficult to comprehend in emotional situations

Ask for comprehension often “Do you see what I mean? Am I making sense?”

Tailor speed of providing information to rate of patient’s comprehension



Do not withhold information or downplay severity to reduce emotional load (may make easier initially, but it may erode trust, may make patient less active in decision making process)

Acknowledge patient’s emotions as they arise

“Empathic Response” – see below

Validation “I can understand why you feel that way”


Strategy and Summary

Also “check in” for patient’s understanding and ready to continue

Treatment, other resources, etc. discussion

Summarize all that’s been said, allow for questions

Plan next visit – to answer more questions, etc.


Empathic Response (Buckman, 2005)

1.       Listen for and identify emotion (mix of emotions)

If you can’t identify the emotion, ask – “How does this make you feel?”


2.       Identify cause of emotion

Most likely the bad news (!)


3.       Show patient you have connected the two

“Obviously/clearly, this news is very upsetting [distressing, a shock]”

Or “I wish I had better news for you.”


You don’t have to experience the emotion to show an empathic response


Baile, W. F., Buckman, R., Lenzu, R., Glober, G., Beale, E. A., & Kudelka, A. P. (2000). SPIKES - A Six-Step Protocol for Delivering Bad News: Application to the Patient with Cancer. The Oncologist, 5, 302-311.



Buckman, R. A. (2005). Breaking Bad news: the SPIKES strategy. Community Oncology, 2(2), 138-142.





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