Breaking Bad News Training (SPIKES)

This course teaches a structured, compassionate approach to breaking bad news using the six-step SPIKES framework. Each step is explained with worked dialogue, and the course covers responding to emotion, cultural and language considerations, sharing news with families, and looking after yourself afterwards.

What you will learn

• Describe each of the six steps of the SPIKES framework and explain why each matters.
• Prepare the setting and yourself before a conversation in which bad news will be shared.
• Use a warning shot, plain language and pauses to share information at the patient's pace.
• Recognise and respond to emotion using empathic statements and silence.
• Agree a clear plan, document the conversation and identify sources of support for the patient and yourself.

Course content

1. What bad news is and why it matters (2 min)
2. The SPIKES framework (1 min)
3. S: Setting up and P: Perception (3 min)
4. I: Invitation and K: Knowledge (3 min)
5. E: Emotions and empathy (3 min)
6. S: Strategy and summary (2 min)
7. Special situations and reflective practice (3 min)
8. Knowledge check (10 questions, 10 min)
9. Guided reflection (15 min)

Standards and guidance covered

• GMC: Good Medical Practice (2024), including the duties on communication, partnership and honesty
• GMC: Decision making and consent (2020)
• GMC: Treatment and care towards the end of life: good practice in decision making
• NMC: The Code (2015, updated 2018), including 'Prioritise people' and 'Communicate clearly'
• HCPC: Standards of conduct, performance and ethics (2024)
• NICE guideline NG31: Care of dying adults in the last days of life, and NICE QS13: End of life care for adults

Certificate

Courses are free to study. When you pass the knowledge check (80%) and complete your reflection, you can buy a verified certificate showing your CPD time, with a unique ID and QR code that anyone can check on our verification page.

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The SPIKES Protocol for Breaking Bad News, With Example Conversations

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Practitioner Insight is an independent education provider. It is not affiliated with or endorsed by the GMC, MPTS, NMC, HCPC, GPhC or any NHS organisation, and this information is not legal advice. If you have been referred to a regulator, speak to your defence organisation, trade union or legal representative.