Breaking bad news
Formal Definition
The process of delivering information that significantly and negatively alters a patient's or family's view of their future; a core clinical communication skill involving structured protocols (SPIKES, NURSE) to ensure the news is delivered compassionately, clearly, and in a manner that preserves the therapeutic relationship and supports the patient's emotional response.
How It's Used on the Ward
"Giving bad news" or "having the hard conversation" — telling a patient they have cancer, or that a loved one has died, or that treatment is no longer working.
Example
""Before I give you the biopsy results, I want to make sure you have someone with you. [Pause.] I'm sorry to tell you that the pathology came back showing cancer. [Stop. Allow silence.] This must be shocking. I want to make sure I answer all your questions. What is coming up for you right now?""
Clinical Context
SPIKES protocol: Setting (private, seated, family present), Perception (what does the patient already know?), Invitation (how much does the patient want to know?), Knowledge (deliver news with warning shot — "I have some difficult news"), Empathy (name and respond to emotion), Strategy/Summary (next steps). NURSE empathy response: Name, Understand, Respect, Support, Explore. Warning shots: "I'm concerned about your test results" before delivering news gives the patient time to prepare. Common mistakes: delivering news in the hallway, giving too much information too fast, not allowing silence, not assessing what the patient heard. Cultural considerations: some families request news be withheld from the patient — this is ethically complex; default to patient-first disclosure unless patient has explicitly delegated.
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