Twelve tips to manage a breaking bad news process: Using S-P-w-ICE-S – A revised version of the SPIKES protocol

Abstract

Breaking bad news (BBN) is a difficult task that requires multiple professional competencies. The way it is managed has implications for all involved in the encounter: the patient, family members, and the news provider. Existing guidelines were developed mainly at the turn of the millennium and require updating based on identification of daily clinical needs and pedagogical challenges while teaching the current protocols. Furthermore, there is a need to provide an overview of BBN encounters as a process, rather than a subdivided event, to help practitioners adopt an approach that might serve them in their daily routines. This twelve tips article summarizes research and practical experience for handling BBN encounters, from their preparation, through delivering the news while attending patients and family members' needs, toward documenting the news, and critically reflecting on the interaction. The tips are structured and explained to serve both practitioners and medical educators.

Keywords:

• Communication skills, breaking bad news, reflective practice
• difficult conversations
• challenging encounters

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Additional information

Notes on contributors

Dafna Meitar

Dr Meitar Dafna, Department of Medical Education, Sackler Faculty of Medicine, Tel Aviv University, Israel.

Orit Karnieli-Miller

Professor Orit Karnieli-Miller, Phd, Department of Medical Education, Sackler Faculty of Medicine, Tel Aviv University, Israel.