Experience Summary

In this experience, watch a doctor break bad news to a patient.

The patient - Mr. Phillip Barry - has been undergoing palliative chemotherapy. He was admitted into the hospital 24 hours ago with pain in his back. The pain has eased with the addition of morphine. A MRI scan of his spine has been performed and Mr. Barry is asking for the results of this as soon as possible as he is very anxious.

The scan report demonstrates widespread metastatic bone disease in the spine. There is no evidence of spinal cord compression. Watch as the doctor explains this to Mr. Barry.

Clinical Context

The SPIKES model is a widely recognised, evidence-based communication framework that supports healthcare professionals in delivering bad news in a structured, compassionate, and patient-centred manner. Breaking bad news is one of the most challenging aspects of clinical practice and can have a significant impact on a patient's emotional wellbeing, understanding of their condition, and trust in healthcare professionals. The SPIKES model helps clinicians navigate these conversations by ensuring information is communicated clearly, sensitively, and with empathy while promoting shared decision-making and patient autonomy.

SPIKES consists of six sequential steps:

1. Setting involves preparing for the conversation by ensuring privacy, minimising interruptions, and creating an appropriate environment for discussion.
2. Perception focuses on exploring the patient's current understanding of their condition, allowing the clinician to tailor the conversation to their level of knowledge.
3. Invitation encourages the clinician to determine how much information the patient wishes to receive, recognising that individual preferences vary.
4. Knowledge involves sharing information in clear, straightforward language, avoiding unnecessary medical jargon, and providing information in manageable amounts to reduce the risk of overwhelming the patient.
5. Emotions requires clinicians to recognise and respond empathetically to the patient's emotional reactions through active listening, validation, and compassionate communication.
6. Strategy and Summary involves collaboratively discussing the next steps, outlining treatment or management options, answering questions, and ensuring the patient understands the plan moving forward.

Reflection Points

How did the doctor do?

Is there anything you would have done differently to the doctor in the experience?

Which elements of the SPIKES model did the doctor use?

How did the doctor explore the patient's concerns?

Learning Outcomes

1. Observe a clinician breaking bad news to a patient.
2. Understand the components of the SPIKES framework to break bad news.

External Resources

• SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer
• Decision making and consent - General Medical Council