Gather information
Understand what the person already knows and what they want.
← How to Break Bad News: The SPIKES Protocol
Lesson
What “bad news” is and the four goals of the conversation
Understand that delivering hard news is a learnable skill, and remember the four goals of such a conversation and the overall SPIKES framework.
Bad news and why you need a protocol
Bad news — and why you need a protocol
“Bad news” is any information that seriously and negatively changes a person's view of their future: a diagnosis, treatment that isn't working, the death of a loved one, a rejection, a dismissal. These conversations are hard on both sides, and most people handle them badly not because they're callous, but because nobody ever taught them how.
The good news is that this is a skill, not an inborn talent. Doctors who were trained in a structured approach deliver hard news more confidently and more gently — and patients feel it.
This conversation has four goals — they're in the cards below. The SPIKES protocol is a simple sequence of six steps that helps you keep all four in view. It was formulated in 2000 by Walter Baile, Robert Buckman, and their colleagues at cancer centers, but it works far beyond medicine.
Four goals of a difficult conversation
Share information
Say it clearly, without jargon, in manageable doses.
Offer support
Notice emotions and respond to them, not to the facts.
Map out a plan
Decide together what happens next.
Lesson notes
Bad news — and why you need a protocol
“Bad news” is any information that seriously and negatively changes a person's view of their future: a diagnosis, treatment that isn't working, the death of a loved one, a rejection, a dismissal. These conversations are hard on both sides, and most people handle them badly not because they're callous, but because nobody ever taught them how.
The good news is that this is a skill, not an inborn talent. Doctors who were trained in a structured approach deliver hard news more confidently and more gently — and patients feel it.
This conversation has four goals — they're in the cards below. The SPIKES protocol is a simple sequence of six steps that helps you keep all four in view. It was formulated in 2000 by Walter Baile, Robert Buckman, and their colleagues at cancer centers, but it works far beyond medicine.