Delivering bad news: the ABCDE and SPIKES protocols

What it is

Bad news should be delivered compassionately and effectively. Five named methods are listed: Rabow and Mc Phee's ABCDE approach, Baile and Buckman's SPIKES approach, the SAAIQ emergency approach from Pakistan, the BREAKS approach by IJPC, and the SAD NEWS approach from Q.U in Canada.

ABCDE: Advance preparation, Build a therapeutic environment, Communicate well, Deal with patient and family reactions, Encourage and validate emotions.

SPIKES stands for: S etting up in privacy; P erceptions of the patient; I nvitation to break news; K nowledge; E motions; S trategy.

SAAIQ: SET the scene as soon as possible; ASSESS the understanding of the attendant; ALERT them that I have bad news; INFORM in clear, understandable words; QUICKLY repeat summary of the situation.

BREAKS stands for: B ackground; R apport; E xplore; A nnounce; K indling; S ummarise.

SAD NEWS: Set up and sit down, Ask don't tell, Deliver the news, No fancy lingo, Expect permit and respond to emotion, Wait, Support and summarise.