SPIKES—A Six-Step Protocol for Delivering Bad News: Application to the Patient with Cancer

TLDR

The study presents the SPIKES protocol, a six‑step method designed to help clinicians effectively disclose bad news to cancer patients by gathering information, transmitting medical facts, providing support, and fostering collaboration on future care. SPIKES comprises six sequential steps that guide clinicians through the disclosure interview. The protocol is straightforward, meets research standards, and has increased clinicians’ confidence in delivering bad news.

Abstract

We describe a protocol for disclosing unfavorable information-"breaking bad news"-to cancer patients about their illness. Straightforward and practical, the protocol meets the requirements defined by published research on this topic. The protocol (SPIKES) consists of six steps. The goal is to enable the clinician to fulfill the four most important objectives of the interview disclosing bad news: gathering information from the patient, transmitting the medical information, providing support to the patient, and eliciting the patient's collaboration in developing a strategy or treatment plan for the future. Oncologists, oncology trainees, and medical students who have been taught the protocol have reported increased confidence in their ability to disclose unfavorable medical information to patients. Directions for continuing assessment of the protocol are suggested.