Clinical Communication & Breaking Bad News Flashcards

Which framework is commonly used for breaking bad news in UK clinical practice?

Answer: SPIKES: Setting, Perception, Invitation, Knowledge, Emotions/Empathy, Strategy/Summary

SPIKES (Buckman, 1992) is the widely used framework for breaking bad news: S — set up the meeting (private, seated, support person); P — assess the patient's Perception; I — obtain the patient's Invitation to discuss findings; K — give Knowledge/information gradually; E — address Emotions with Empathy; S — Strategy and Summary with a plan.

When breaking bad news, what does 'warning shot' mean?

Answer: Giving a preparatory phrase before delivering bad news to allow the patient to mentally prepare ('I'm afraid the results are more serious than we hoped...')

A 'warning shot' is a brief phrase that signals difficult news is coming, giving the patient a moment to prepare emotionally before hearing the details. Examples: 'I'm afraid the news is not as good as we hoped' or 'The results have shown something we need to discuss seriously.' It prevents the patient from being completely blindsided.

After breaking bad news of a cancer diagnosis, the patient becomes angry and says 'You must have made a mistake — how could you have missed this earlier?' How should you respond?

Answer: Acknowledge the patient's anger with empathy ('I understand you're very angry and this must be a terrible shock'), allow them to express feelings, and avoid becoming defensive

Anger is a common and normal response to bad news (part of the Kübler-Ross model: denial, anger, bargaining, depression, acceptance). The most effective response is to acknowledge and validate the emotion without becoming defensive. Once the patient feels heard, you can address factual questions. Responding defensively escalates the situation.

A patient has been told they have terminal cancer. They ask 'How long have I got?' How should you respond?

Answer: Explore what the patient is really asking; give a range if asked for specifics; avoid false certainty while not removing all hope; check what they want to plan for

Prognosis questions require a careful, honest, and compassionate approach. First clarify what the patient really wants to know and why. If they want specifics, provide a range honestly but acknowledge uncertainty. Maintain realistic hope (for quality of life, symptom control, meaningful time). False reassurance or overly pessimistic statistics are both harmful.

During a consultation about a patient's terminal illness, what is the purpose of checking understanding (the 'chunk and check' technique)?

Answer: To deliver information in small pieces and regularly check comprehension, so the patient can absorb what they have been told and ask questions

'Chunk and check' involves giving a small amount of information, then pausing to check understanding and invite questions before continuing. In emotionally charged consultations (breaking bad news), patients retain little after the initial shock — chunking ensures information is absorbed and allows the patient to guide the pace of the consultation.

A patient requires a lifestyle change (stopping smoking, starting exercise). Which communication approach is most likely to be effective according to evidence?

Answer: Motivational interviewing — exploring the patient's own motivation, identifying ambivalence, and supporting self-efficacy, rather than directing or lecturing

Motivational interviewing (Miller and Rollnick) is an evidence-based communication style for behaviour change. Key elements: express empathy, develop discrepancy between current behaviour and the patient's own goals, roll with resistance rather than confront it, and support self-efficacy. It is more effective than advice-giving or direct confrontation.