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The SPIKES protocol is a method used in clinical medicine to break bad news to patients and families.[1][2][3][4][5][6][7] As receiving bad news can cause distress and anxiety,[7] clinicians need to deliver the news carefully.[8] By using the SPIKES method for introducing and communicating information to patients and their families, it can aid in the presentation of the material. The SPIKES method is helpful in providing an organized manner of communication during situations that are typically complex and difficult to communicate. According to research related to the SPIKES method, important factors to consider when using this protocol involve empathy, acknowledgement and validation of feelings, providing information about intervention and treatment, and ensuring that the patient understands the news being delivered.[1]

The protocol was first proposed in 2000 by Baile et al, in the context of oncology.[9][10]

The name SPIKES is an acronym, where the letters stand for:[9][1][8]

S: setting, i.e. setting up the consultation appropriately:

→ This entails never to give bad news by use of phone or in a hallway. One may consider to sit in a private space or room with no distractions so to be sure the message being delivered is the one focused on; no use of televisions or cellphones. Ensure that you face both the patient and the family and establish therapeutic alliance or connection by use of eye contact and physical touch, i.e. holding a hand or touching an arm.

P: perception, i.e. assessing the patient's perception of the situation

→ Begin by asking the patient what they believe is going on. This not only allows you to find out what they know about the situation, but also engages the patient. It allows for them to realize what they think matters, and forms a starting point for how to proceed. It is important to listen to what the patient tells you as this is the first place to correct any misconceptions that are held right away.[11][12]

I: invitation, i.e. prompting the patient to invite the clinician to deliver the news

→ Using phrases such as "Shall I share the results of the scan with you now?" or "Is this a good time to share with you what I believe is going on?" allow for the patient to decide if they are ready to hear more and also allows for open discussion to follow. Phrasing is important as you are essentially asking for permission to share unpleasant news with them. The way it is worded shows respect for the patient's feelings and reflects on their readiness to receive news.[11]

K: knowledge, i.e. providing the knowledge to the patient

→ Speak slowly, maintain eye contact, and use terms both parties can understand. This is the time to explain what the bad news means for the patient. Beware of adding extra details right away as this is the place to be clear and concise of what is happening.

E: empathy, i.e. empathizing with the impact of the news on the patient

→ Often it is hard to fully understand what is going through the patient's or families' minds. Silence is often best instead of speaking out as everyone is processing emotions. When you feel it is the right time to speak, speak out of empathy and acknowledge that your patient is feeling something. Do not discourage tears or silence, this may be a processing strategy that is necessary to fully come to terms with the situation. Provide support.[11]

S: strategy, i.e. devising a strategy for what to do next

→ Summarize all thoughts and decide where to go from here. Options to discuss may be treatment, setting another meeting, discussing hospice care, or many others. Each situation is unique and it is best to do what is in the best interest of the patient's needs and wants.[13]


1) Kaplan, Marcelle (1 August 2010). "SPIKES: A Framework for Breaking Bad News to Patients With Cancer". Clinical Journal of Oncology Nursing. 14 (4): 514–516. doi:10.1188/10.CJON.514-516. PMID 20682509.

2) Dean, Antonia; Willis, Susan (2 June 2016). "The use of protocol in breaking bad news: evidence and ethos" (PDF). International Journal of Palliative Nursing. 22 (6): 265–271. doi:10.12968/ijpn.2016.22.6.265. PMID 27349844.

3) Seifart, C.; Hofmann, M.; Bär, T.; Riera Knorrenschild, J.; Seifart, U.; Rief, W. (2014). "Breaking bad news–what patients want and what they get: evaluating the SPIKES protocol in Germany". Annals of Oncology. 25 (3): 707–711. doi:10.1093/annonc/mdt582. PMC 4433514. PMID 24504443.

4) de Moura Villela, Edlaine Faria; Bastos, Luana Kronit; de Almeida, Wanderson Sant’ana; Pereira, Andressa Oliveira; de Paula Rocha, Matheus Silva; de Oliveira, Fábio Morato; Bollela, Valdes Roberto (14 February 2020). "Effects on Medical Students of Longitudinal Small-Group Learning about Breaking Bad News". The Permanente Journal. 24. doi:10.7812/TPP/19.157. PMC 7039420. PMID 32097117.

5) Servotte, Jean-Christophe; Bragard, Isabelle; Szyld, Demian; Van Ngoc, Pauline; Scholtes, Béatrice; Van Cauwenberge, Isabelle; Donneau, Anne-Françoise; Dardenne, Nadia; Goosse, Manon; Pilote, Bruno; Guillaume, Michèle; Ghuysen, Alexandre (November 2019). "Efficacy of a Short Role-Play Training on Breaking Bad News in the Emergency Department". Western Journal of Emergency Medicine. 20 (6): 893–902. doi:10.5811/westjem.2019.8.43441 (inactive 2020-09-01). PMC 6860397. PMID 31738716.

6) Alves, Carolina Guimarães Bonfim; Treister, Nathaniel Simon; Ribeiro, Ana Carolina Prado; Brandão, Thaís Bianca; Tonaki, Juliana Ono; Lopes, Marcio Ajudarte; Rivera, César; Santos-Silva, Alan Roger (November 28, 2019). "Strategies for communicating oral and oropharyngeal cancer diagnosis: why talk about it?". Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 129 (4): 347–356. doi:10.1016/j.oooo.2019.11.014. PMID 31928903.

7) Zheng, Ying; Lei, Fang; Liu, Bao (14 December 2019). "Cancer Diagnosis Disclosure and Quality of Life in Elderly Cancer Patients". Healthcare. 7 (4): 163. doi:10.3390/healthcare7040163. PMC 6956195. PMID 31847309.

8) "Ask the Hematologist: SPIKES Protocol For Delivering Bad News to Patients". July 1, 2017.

9) Baile, Walter F.; Buckman, Robert; Lenzi, Renato; Glober, Gary; Beale, Estela A.; Kudelka, Andrzej P. (August 2000). "SPIKES—A Six‐Step Protocol for Delivering Bad News: Application to the Patient with Cancer". The Oncologist. 5 (4): 302–311. doi:10.1634/theoncologist.5-4-302. PMID 10964998.

10) "Breaking bad news - The MDU".


12) Monden, Kimberley R.; Gentry, Lonnie; Cox, Thomas R. (11 December 2017). "Delivering Bad News to Patients". Baylor University Medical Center Proceedings. 29 (1): 101–102. doi:10.1080/08998280.2016.11929380. PMC 4677873. PMID 26722188.

13) Mostafavian, Zahra; Shaye, ZahraAbbasi (2018). "Evaluation of physicians' skills in breaking bad news to cancer patients". Journal of Family Medicine and Primary Care. 7 (3): 601–605. doi:10.4103/jfmpc.jfmpc_25_18. PMC 6069664. PMID 30112317.

(Source: November 14th, 2020)