Breaking Bad News: Spikes Protocol for Healthcare Professionals

Conveying bad news is a skilled communication, and not at all easy. The amount of truth to be disclosed is subjective. A properly structured and wellorchestrated communication has a positive therapeutic effect.

Lack of sufficient training in breaking bad news is a handicap to most physicians and health care workers. Adherence to the principles of clientcentered counseling is helpful in attaining this skill. Fundamental insight of the patient is exploited and the bad news is delivered in a structured manner, because the patient is the one who knows what is hurting him most and he is the one who knows how to move forward. Sixstep SPIKES protocol is widely used for breaking bad news

This model was given by Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP (2000) SPIKES PROTOCOL. This acronym 'SPIKES" nevertheless helps memories the steps and consider their elements

STEP 1: SETTING UP the Interview
STEP 2: Assessing the Patient’s PERCEPTION
STEP 3: Obtaining the Patient’s INVITATION
STEP 4: Giving KNOWLEDGE and Information to the Patient
STEP 5: Addressing the Patient’s EMOTIONS with empathic responses
STEP 6: Strategy and Summary

For more information read this article Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP (2000) SPIKES – A SixStep Protocol for Delivering Bad News: Application to the Patient with Cancer. Oncologist 5:302311