Delivering 'Bad' vs 'Serious' News to Patients

Neil Chesanow


January 27, 2016

In This Article

Delivering the News

The K in SPIKES stands for knowledge. This refers to how you structure the information you impart. Telling the patient that you have some serious news to discuss, for example, allows the patient to prepare psychologically to receive the information. Pause to let this sink in. Then use language to match the patient's level of education.

"Avoid delivering all of the information in a single, steady monologue," the AMA advises.[4] Avoid using jargon that may confuse the patient. And avoid using indirect or euphemistic language in an attempt to soften the news, which may also create confusion. It's better to be direct.

"When you don't use definitive words, it's hard for patients to grasp what actually has happened," Dr Campbell observes. "When I was a resident, I was taught that when you tell a family there's a negative outcome, you don't say, 'Your husband has passed away' or 'Your husband has moved on.' You say, 'I'm very sorry to tell you that your husband has died. This is the situation; this is what we think happened.' You have to be very definitive."

The AMA offers several other examples[4]:

  • Mr Gonzales, I feel badly to have to tell you this, but the growth turned out to be cancer.

  • I'm afraid the news is not good. The biopsy showed that you have colon cancer.

  • The report is back, and it's not as we had hoped. It showed that there is cancer in your colon.

"When I deliver bad news, I talk about exactly what's going on, what it means, and what the potential impact is," Dr Campbell elaborates. "I talk with the patient about what the possibilities are for therapy and the pros and cons of the different possibilities. Then we talk about what the outcome might ultimately be. I then give the patient an opportunity to ask questions."

"I try to teach doctors to give a headline first, then pause to let the information sink in, and then fill in the details," Dr Back explains. "Many doctors will try to tell the whole story of how the illness was diagnosed: 'You had this test, and that test, and this other test. This sometimes means this, and then there's positive predictive value in that'—and the patient is lost."

A more effective approach is to tell the patient that, for example, "Your latest blood test shows you have diabetes." Or, "Your CAT scan shows that your cancer has come back." Then pause to let the patient digest this news, Dr Back advises. "And then go into the details."


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