Communication
CPSA · Communication · Sharing difficult news
Breaking bad news
Use the SPIKES framework: deliver serious news honestly, at the patient’s pace, responding to emotion. The single most tested comms scenario.
The framework
S — Setting
- Private room, sit down, no interruptions (bleep away), offer a chaperone/relative
- Introduce yourself, confirm identity, check who they’d like present
P — Perception
- Find out what they already know and understand — “What have you been told so far?”
I — Invitation
- Ask how much they want to know — “Are you the kind of person who likes all the details?”
K — Knowledge
- Fire a warning shot — “I’m afraid I have some difficult news.”
- Give information in small chunks, plain language, then pause
- Avoid jargon and euphemisms; be honest and clear
E — Emotions
- Respond to the emotion — “I can see this is a shock.” Allow silence; offer tissues
- Acknowledge and validate; don’t rush to reassure
S — Strategy & summary
- Give a clear plan and next steps; check understanding
- Offer written information, support and a point of contact; safety-net; arrange follow-up
Phrases that work
- “I’m afraid the results are not what we’d hoped.” (warning shot)
- “Take all the time you need.” (after silence)
- “I don’t know the answer to that, but I’ll find out for you.” (honesty)
- “Is there someone you’d like me to call?”
Pitfalls that lose marks
- Filling the silence too quickly with facts or false reassurance.
- Using euphemisms (“growth”, “passed away”) that obscure the message.
- Overloading with a monologue instead of chunking and checking.
- Forgetting to arrange follow-up and support.