Teaching the SPIKES model for delivering bad news

Communicating bad news in a clinical setting is a core skill that many teachers need to model for learners.

The SPIKES framework

SPIKES is a six‑stage approach that gives a clear structure to a difficult conversation. It was developed to help clinicians plan and deliver bad news in a way that respects the patient and supports the clinician's confidence.

• **S** – Setting up the interview: arrange a private space, ensure no interruptions, check equipment.
• **P** – Assessing the patient’s Perception: ask what the patient already knows.
• **I** – Obtaining the patient’s Invitation: clarify how much detail they want.
• **K** – Giving Knowledge and information: share facts clearly, avoid jargon.
• **E** – Addressing Emotions with Empathy: recognise emotional response and validate it.
• **S** – Summarising and Strategising: outline next steps and offer support.

Teaching each stage separately can overload learners. Instead, integrate the steps into a single scenario that moves naturally from one stage to the next.

Designing role‑play scenarios

A realistic role‑play starts with a brief case vignette. Choose a condition that is common enough for learners to be familiar with, such as a new cancer diagnosis or a serious infection requiring intensive care. Provide actors with a short script that includes the key factual points, but leave room for improvisation.

Key design tips

• Keep the scenario length to 10–15 minutes to maintain focus.
• Give the learner a clear objective, for example "communicate a diagnosis and discuss treatment options".
• Use a checklist that aligns with the SPIKES steps so the observer can note where the learner succeeds or needs improvement.

The role‑play should be followed by a structured debrief. This is where deeper learning happens.

Reflective debriefing techniques

Debriefing works best when it follows a simple, repeatable format. The three‑phase model of "What happened?", "What did you think?", and "What will you do differently?" encourages reflection without judgment.

• **What happened?**: The observer and learner recount the interaction, focusing on observable behaviours.
• **What did you think?**: The learner shares their internal experience – emotions, assumptions, and uncertainties.
• **What will you do differently?**: Together they identify concrete actions for the next encounter.

Encourage learners to link each comment to a specific SPIKES stage. This reinforces the framework and helps them see gaps in their approach.

Cultural sensitivity in bad‑news communication

Cultural background influences how patients receive and process difficult information. In a classroom setting, bring this to the fore by varying the simulated patient’s cultural context.

• Explain briefly any cultural norms that may affect communication, such as preferences for family involvement or reliance on spiritual support.
• Ask learners to ask open‑ended questions about the patient’s values before delivering the news.
• Highlight the importance of using an interpreter when language barriers exist, and practise the timing of interpreter introduction.

By embedding cultural cues into role‑play, you prepare learners for the diversity they will encounter in practice.

Putting it together in a classroom

A typical session can be organized as follows:

1. **Introduction (5 min)** – Outline learning objectives and the SPIKES model.

2. **Demonstration (5 min)** – Show a short video or live demonstration of a skilled clinician using SPIKES.

3. **Role‑play (15 min)** – Learners pair up; one acts as clinician, the other as patient.

4. **Debrief (10 min)** – Use the three‑phase reflective format.

5. **Wrap‑up (5 min)** – Summarise key points, answer questions, and direct learners to further resources such as our flashcards or the how‑it‑works guide.

Repeating this cycle with different case vignettes and cultural contexts builds competence and confidence. Over time, learners will internalise the SPIKES steps and adapt them to the nuances of each patient encounter.

Resources for teachers

• A printable SPIKES checklist for observers.
• A bank of case vignettes with cultural variations.
• Tips for creating a safe learning environment where mistakes are seen as learning opportunities.

These tools can be found in the SlideBites guides section and can be customised for your local curriculum.

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By structuring teaching around the SPIKES model, role‑play, reflective debriefing, and cultural awareness, you give trainees a reproducible method for delivering bad news. The approach is practical, evidence‑based, and adaptable to the varied settings that UK clinicians encounter.