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The Oncologist, Vol. 5, No. 4, 302-311, August 2000
© 2000 AlphaMed Press

SPIKES—A Six-Step Protocol for Delivering Bad News: Application to the Patient with Cancer

Walter F. Bailea, Robert Buckmanb, Renato Lenzia, Gary Globera, Estela A. Bealea, Andrzej P. Kudelkab

a The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; b The Toronto-Sunnybrook Regional Cancer Centre, Toronto, Ontario, Canada

Correspondence: Walter F. Baile, M.D., 1515 Holcombe St., Box 100, Houston, Texas 77030, USA. Telephone: 713-792-7546; Fax: 713-794-4999; e-mail: wbaile{at}mdanderson.org

We describe a protocol for disclosing unfavorable information—"breaking bad news"—to cancer patients about their illness. Straightforward and practical, the protocol meets the requirements defined by published research on this topic. The protocol (SPIKES) consists of six steps. The goal is to enable the clinician to fulfill the four most important objectives of the interview disclosing bad news: gathering information from the patient, transmitting the medical information, providing support to the patient, and eliciting the patient's collaboration in developing a strategy or treatment plan for the future. Oncologists, oncology trainees, and medical students who have been taught the protocol have reported increased confidence in their ability to disclose unfavorable medical information to patients. Directions for continuing assessment of the protocol are suggested.

Key Words. Neoplasms • Physician-patient relations • Truth disclosure • Educational models




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