Breaking the Bad News

One of the most challenging tasks for a physician is breaking bad news to a patient. It is essential to break the news in a structured fashion, with adequate advanced preparation and a good follow up plan. This can often help allay some patients’ fears.

Steps to Prepare for the Conversation

  • Review the case - Doing a thorough case review, with emphasis on the severity of the illness and history of any interventions, is essential for preparing to break bad news.
  • Set an agenda for the conversation – Objective of conveying bad news is to deliver the news clearly, with empathy and setting up a strategy for future care, by use of a script or practicing relevant words & phrases.
  • Anticipate difficult questions – Being prepared for difficult questions like ‘Why me?’ can help you handle the conversation in a better manner, especially if the patient has a history of aggressive behavior.
  • Enlist Help - Enlisting the help of another caregiver involved in the patient’s care is mutually beneficial to both patients and physicians.
  • Prepare emotionally - Remind yourself that in case of any conflict, your professional judgment should guide the conversation, and not your personal values.

Conveying the Bad News

  • Breaking the news -Bad news can be broken in a gentle, sensitive manner, and at the individual's pace. Some individuals will not wish to hear the whole diagnosis straightaway but may be more concerned with the care that is planned. If news is given too bluntly, it may lead to denial.
  • After breaking the news -There is always some level of shock after bad news, so some time should be given before attempting to pick up the pieces by exploring feelings and identifying concerns.

A Useful Protocol for Breaking Bad News

You may use the pneumonic code SPIKES, which is a six-step protocol, often used to improve confidence while breaking bad news to patients with life-threatening illness:

  • Setting up the interview.
  • Assessing the patient's Perception.
  • Obtaining the patient's Invitation to discuss, as shunning information is a valid psychological coping mechanism.
  • Giving Knowledge and information to the patient.
  • Addressing the patient's Emotions with Empathetic response.
  • Having a Strategy and Summarizing.

Download Patient Information Kit


  • Shetty AA, Shapiro J. How To Break Bad News–Tips And Tools For Resident Physicians. Journal of Medical Education Perspectives. 2012 Jun 18; 1(1).
  • Faulkner A. ABC of palliative care. Communication with patients, families, and other professionals. BMJ: British Medical Journal. 1998 Jan 10; 316(7125):130.
  • Breaking Bad News. NHS UK. [document on the internet]. [Cited 2017 March 10]. Available at: