1. Effective Patient
Communication
Module 2: Sharing Bad News
Module development supported by a grant from the
Picker Institute / Gold Foundation 2010 Challenge Grant

2. Learning Objectives
 Define bad news
 Demonstrate use of the SPIKES model when
sharing bad news with the patient
 During the patient encounter, attend to the major
emotional components of sharing bad news,
especially expressions of fear, anger, sadness,
denial, and guilt
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3. Expected Outcomes
 Recognize challenges and supports to effectively
sharing bad news with the patient & family
 Demonstrate the SPIKES model communication
strategy when sharing bad news with the patient &
family
 Demonstrate empathy when sharing bad news
with the patient
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4. The Task of Breaking Bad News
“If we do it badly, the patients or
family members may never
forgive us; if we do it well, they
may never forget us.”(Buckman, 1992)
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5. What is Bad News?
Information that
negatively alters
the patient’s
view of the
future
(Buckman, 1992) (Tissot, 1872)
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6. Challenges
 Lack of:
 Guidelines
 Training
 Experience
 Good role models
 Concerns of:
 The provider
(Siegmund, 2008)  The patient & family
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7. Supporting Patient & Provider
 Patient & Family are supported by:
 Being included in conversations & planning
 Being treated as care partners
 Provider is supported by:
 Training & Practicing good communication skills
 Learning ways to effectively cope with emotionally
charged issues
 Having another person available who knows the patient
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8. SPIKES Model: The Six Steps
 Setting
 Perception
 Invitation
 Knowledge
 Emotions
 Strategy & Summary
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, 5, 302-311; 2000. SPIKES mnemonic used with permission.
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9. Setting the Environment
 Provide privacy
 Introduce self
 Determine who else should be present
 Ensure no interruptions
 Provide comfortable space
 Create welcoming environment
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10. Perception
 Prepare before
speaking
 Ask about patient’s
perception of what is
going on
(Renoir/ Bjoertvedt, 2010)
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11. Invitation
 Ask questions to invite
the patient into
conversation
 Ask how much
information the
patient wants to hear
(Pissarro, 1881)
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12. Knowledge
 Deliver the message
 Use plain language
 Be mindful of body language
 Get to the point
 Give information in small chunks
 Pause
 Wait for reaction
 Use “teach back” to verify that message was
received
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13. Emotions and Empathy
 Be prepared for patient’s and family’s emotional
response
 Anticipate fear, anger, sadness, denial, guilt
 Be mindful of your own response
 Comfort the patient
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14. Strategy and Summary
 Assess patient’s readiness for planning
 Negotiate next steps
 Verify support structure
 Acknowledge & answer questions
 Summarize plan
 Use “teach back” technique
 Follow-up
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15. Video
©2009 –“Sharing Bad News” Henry Ford Health System Department of Medical Education Video clip used with permission.
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16. Discussion of the Video
 How well did the doctor handle the situation?
 What worked well?
 What could have been handled better?
 Have you experienced a scene like the one shown?
 What was your role?
 Describe the encounter
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17. What’s Next?
Expectations
Reminders
(Mahmud, 2008)
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18. Special Thanks
Module Development supported by a grant from the
Picker Institute/ Gold Foundation 2010 Challenge Grant
©2009 –“Sharing Bad News” Henry Ford Health System
Department of Medical Education
The DHMC Patient and Family Centered Care Department,
and Chaplaincy
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19. References
American Academy on Communication in Healthcare (AACH). Enhancing Communication Skills.
http://www.aachonline.org/?page=EnhanceCommSkills. Accessed October 20, 2010.
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, 5, 302-311; 2000.
Bjoertvedt. File: Auguste Renoir Conversation.JPG. National Museum Stockholm; 2008. Wikimedia Commons.
http://commons.wikimedia.org/wiki/File:Auguste_Renoir_Conversation.JPG. Accessed December 6, 2010.
Boyle WE, Colacchio TA. Patient and Family Centered Care at Dartmouth-Hitchcock. [DVD]. Lebanon, NH: Dartmouth-
Hitchcock Media Services; 2010.
Bub B. Communication Skills That Heal. United Kingdom: Radcliffe Publishing Ltd; 2006.
Buckman R. How to Break Bad News: A Guide for Health Care Professionals. Baltimore, MD: The Johns Hopkins University
Press; 1992.
Buckman R. Talking to Patients About Cancer. BMJ, 313, 699-700; 1996.
Coulehan JH, Block MR. The Medical Interview, Mastering Skills for Clinical Practice. 5th ed. Philadelphia, PA: F.A. Davis
Company; 2006.
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20. File: James Tissot-Bad News.jpg. National Museum Cardiff; 1872. Wikimedia Commons.
http://commons.wikimedia.org/wiki/File:James_Tissot_-_Bad_News.jpg. Accessed December 6, 2010.
File:Pissarro Conversation.jpg. Tokyo: The National Museum of Western Art; 1881. Wikimedia Commons
http://commons.wikimedia.org/wiki/File:Pissarro_Conversation.jpg.. Accessed December 6, 2010.
Frampton S, Guastello S, Brady C, Hale M, Horowitz S, Smith SB, Stone S. Patient-Centered Care Improvement Guide. Picker
Institute; 2008. http://pickerinstitute.org/wp-content/uploads/2010/06/pcc_improvement_guide.pdf. Accessed October 29,
2010.
Henry Ford Health System Department of Medical Education. Sharing Bad News. [DVD]. Detroit, MI: Henry Ford Health
System; 2009.
Lloyd M, Bor R. Communication Skills for Medicine. 3rd ed. London: Elsevier; 2009.
Mahmud A. File: Serious Discussion image by Ashfaq.JPG. Dhaka University Institute of Fine Arts; 2008. Wikimedia Commons.
http://commons.wikimedia.org/wiki/File:Serious_Discussion_image_by_Ashfaq.JPG. Accessed December 6, 2010.
Rider EA, Nawotniak RH, Smith G. A Practical Guide to Teaching and Assessing the ACGME Core Competencies.
Marblehead, MA: HCPro, Inc; 2007.
Siegmund W. File: Mount Rainier 5839.JPG. 2008. Wikimedia Commons.
http://commons.wikimedia.org/wiki/File:Mount_Rainier_5839.JPG. Accessed December 6, 2010.
Weiss BD. (2007). Removing Barriers to Better, Safer Care, Health Literacy and Patient Safety: Help Patients Understand,
Manual for Clinicians. 2nd ed. American Medical Association Foundation and American Medical Association.
http://www.ama-assn.org/ama1/pub/upload/mm/367/healthlitclinicians.pdf. Accessed December 15, 2009.
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