Breaking bad news
Situations in which it is necessary to deliver bad news to a patient or their relatives usually expose doctors or other healthcare professionals to increased emotional stress. In clinical practice, healthcare professionals of any specialty may face the need to communicate serious issues with patients or their families at varying degrees of intensity. Standardized procedures, particularly the SPIKES protocol, have been developed to help manage these difficult situations effectively. This algorithm outlines the individual steps of the SPIKES protocol.
Review
The question-and-answer format used in the presentation offers an interactive approach, allowing participants to reflect on the individual steps involved in delivering bad news. I appreciate that when you select individual answers – whether correct or incorrect – a window then appears with a fairly detailed explanation, which serves an educational purpose. The explanations are written clearly and are sufficiently comprehensive. The individual steps refer to points from the SPIKES protocol for delivering bad news. I also find the use of incorrect answers in the presentation to be beneficial; these are sometimes chosen in a humorous way and enhance the interactivity of the presentation. It is important to provide a clear explanation of areas such as the appropriate setting for delivering bad news, the use of silence, and the importance of conveying the most sensitive information concisely and clearly. I also think it’s excellent that the presentation highlights situations where it is appropriate for a doctor to apologise or prepare the patient for the fact that the circumstances for delivering bad news are not ideal. The video in the presentation is very well chosen and draws the viewer into the process in an interactive way. I appreciate that the information provided in the presentation is generally applicable not only to delivering bad news, but also to good doctor–patient communication in general. Despite minor shortcomings, I consider the treatment of the subject matter to be good, presented in an interesting and interactive way, and educationally valuable.
Sources
BAILE, Walter F. et al. SPIKES—A six-step protocol for delivering bad news: application to the patient with cancer. The Oncologist. 2000, roč. 5, č. 4, s. 302–311. DOI: 10.1634/theoncologist.5-4-302.
SLÁMA, Ondřej; VAFKOVÁ, Tereza. Paliativní péče: multimediální elektronický výukový materiál. 1st ed. Brno: Masaryk University, 2020. ISSN 1802-128X. ISBN 978-80-210-9628-8. Available from: [https://is.muni.cz/do/rect/el/estud/lf/ps19/paliativni_pece/web/index.html]. [7.4.2026]
PECHAČOVÁ, Zdeňka; DRBOHLAVOVÁ, Tereza; LOHYNSKÁ, Radka. Praktické strategie sdělování závažných zpráv v onkologii. Onkologie, 2022, vol. 16, no. 1, pp. 50–52. DOI: 10.36290/xon.2022.009.
KÜBLER-ROSS, Elisabeth. On Death and Dying: What the Dying Have to Teach Doctors, Nurses, Clergy and Their Own Families. New York: Macmillan, 1969. ISBN 978-0020891300.
Learning targets
2. The student knows how to proceed when delivering negative news and how to phrase it.
3. The student can respond appropriately to the patient’s emotions and provide support.
4. The student learns about the main mistakes made when delivering negative news.
Key points
2. Using a specific protocol, such as SPIKES, can improve the quality and effectiveness of communication.
3. The specific negative news is delivered concisely and clearly (“the warning shot” and “the one-line headline”).
4. We acknowledge the patient’s emotions, express empathy and support, and use silence effectively.
