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Nobody wants to be the bearer of bad news, but it is inevitable when you work in healthcare. Informing a patient about an illness or health risk can be daunting for a number of reasons. Bad news causes distress, which can affect a person’s rationality and communication. The usage of medical jargon can lead to frustration because both sides are not able to reach mutual understanding. Though the patient’s health is a top priority, there is a way for nurses to simultaneously take care of their patient’s emotions while delivering bad news.

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The SPIKES Protocol is a strategy used to deliver bad news in a compassionate, yet effective manner, and has positively affected nurse-patient communication and collaboration on future health plans. We have simplified this six-step process so new nurses can review the skill of delivering bad news in healthcare.

The Six Steps of SPIKES


The first step is to establish a safe environment where the patient can feel comfortable in. If necessary, the patient may allow a loved one to sit in the room as moral support. It is recommended that both the nurse and patient (and other parties) be sat down and eye-level to establish common ground. Before breaking into the bad news, try to establish a connection with the patient.


You may slowly introduce the illness to the patient, but use this time to learn about the patient’s perceptions and knowledge about the illness. Rather than focusing on correctness, try to gauge how the patient feels towards the illness and prepare them for the news. You may be greeted with denial, but for now, allow the patient time to process their feelings.


Establish support by reminding the patient that as a nurse, you are there to help them in any way, acting as a resource for any questions or clarifications. Asking the patient if they wish to know more about the medical condition is an effective way to progress the conversation, but respect their right to not know (at least in that moment).


Offering the positives first is a good transition. Simplifying medical jargon and delivering the news in manageable pieces can make all the difference for the patient. Occasionally check-in with the patient to seek confirmation that they understand the assessment before moving on to the next topic.


Monitor the patient’s emotions throughout the conversation and stay active in listening for the source of where the emotion is coming from. For example, a patient may be concerned over money matters and forego treatment. Respond empathetically and validate their concern while bringing up possible solutions to explore.

Summary and Strategy

After giving the bad news and helping the patient navigate through the information and their emotions, the next step is to set up a health plan. Offering suggestions for target dates is good, but ultimately, the patient should be able to dictate the next course of action they see fit.The SPIKES Protocol aligns with our values at Eisenhower Health. Learn more about our Culture at Eisenhower Health; and search for opportunities to work at our world-class medical center at our Career page.

Originally posted on 17/12/2019

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