1. The S-P-I-K-E-S Six-Step Protocol Dr Robert Buckman & Dr Walter Baile
How To Break Bad News
The S-P-I-K-E-S Six-Step Protocol
Dr Robert Buckman & Dr Walter Baile

2. Breaking Bad News A Definition:
Bad news is any news that seriously and adversely affects the patient’s view of his or her future

3. Breaking Bad News The main objective is to separate
THE MESSENGER from THE MESSAGE
so that
even though the message is bad,
the messenger can be seen as part of the support system

4. Breaking Bad News What are we trying to achieve?
The central objective is to ENHANCE and REINFORCE the patient’s OWN COPING STRATEGIES

5. Breaking Bad News S Getting the SETTING right
P What the patient PERCEIVES
I An INVITATION to share the news
K Giving the KNOWLEDGE....
E EMPATHISING & EXPLORING the patient’s emotions
S STRATEGY and SUMMARY

6. Breaking Bad News S - SETTING Physical Context Listening Skills
body language, eye contact (“not when hot”) and positioning
Listening Skills
silence (pauses etc), repetition, other facilitation techniques, touch

7. Breaking Bad News P - Finding Out What the Patient Knows or PERCEIVES
Different ways of asking
Assess vocabulary & comprehension
Note denial (if present)

8. Breaking Bad News
I - INVITATION by the Patient To Share The Information
Different ways of asking
“Are you the sort of person who...”
Accept right not to know
Aim to get clear invitation

9. Breaking Bad News K - Giving the KNOWLEDGE and Medical Facts
Aligning = starting at a point compatible with the patient’s current comprehension

10. Breaking Bad News K (continued) Giving KNOWLEDGE
Small chunks - check reception
English not Medspeak
Tailor the delivery of information to the person’s response
Acknowledge all responses

11. Breaking Bad News E - EMPATHISING & EXPLORING: The Empathic Response
Identify the emotion (theirs or yours)
Identify the source of the emotion
Respond in a way that shows you have made that connection
You don’t have to feel the emotion yourself
You don’t have to agree with the viewpoint

12. Breaking Bad News
E-V-E The key to addressing emotions Each response should be one of these
EXPLORING
VALIDATING
EMPATHIC

13. Breaking Bad News S - STRATEGY & SUMMARY
Make a plan, then explain and collaborate with the patient
Summarise main areas
“Any questions for now?”
Contract for next contact

14. Breaking Bad News
“ Breaking bad news is never easy or pleasant: but at least having some plan or approach increases the professional’s feeling of confidence - and that is often perceived as increased competence.”

15. Breaking Bad News drbuckman.com
For more information on the videos, CD-ROMs, Pocket Guides, books and articles:
drbuckman.com