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More facilities are offering workshops to health care professionals who want to be better at delivering bad news and handling difficult discussions. One protocol for delivering bad news to patients is called SPIKES, which stands for these six key elements.


Setting up the interview: Pick a private location.


Perception: Assess how the patient views her medical situation.


Invitation: Ask her if she wants to know more.


Knowledge: Give her information and warn her before giving bad news.


Emotions: Address the patient's emotions with empathetic responses.


Strategy/Summary: Review the basics of what you've told the patient and include her in treatment decisions.


A variation of this protocol, SPIKES RN, provides a template for nurses who need to have a potentially difficult conversation with a physician about breaking bad news to a patient.


Another workshop, called the Program to Enhance Relational and Communication Skills (PERCS), was developed at Children's Hospital Boston. Using role-playing with actors, this day-long workshop helps clinicians improve interactions with children and their families on such sensitive topics as end-of-life treatment decisions, organ donation, and disclosure of medical error.


For more on SPIKES, visit The University of Texas MD Anderson Cancer Center Web site at and click on "communication skills for medical professionals." For more information on PERCS, visit the National Association of Children's Hospitals and Related Institutions Web site at and search for PERCS.




SPIKES-A six-step protocol for delivering bad news: Application to the patient with cancer, The Oncologist, WF Baile, et al., August 2000.