title: The use of protocol in breaking bad news: evidence and ethos.
abstract: This article discusses health professionals use of protocol in the breaking of bad news, focusing particularly on the well-known SPIKES framework. The evidence of impact on the patient experience is examined and recommendations are made for further outcome-based research. Existing evidence suggests that the model as commonly interpreted may not fully meet the needs of patients or reflect the clinical experience of breaking bad news for some professionals and further guidance may be needed to support them in their practice. The ethos of the step-wise protocol is debated, questioning whether it helps or hinders individualised care and the formation of a genuine relationship between patient and professional. Finally, recommendations for practice are offered.
authors.affiliation: Lecturer Practitioner, Hospice of St Francis, Berkhamsted, UK.
authors.forename: Antonia
authors.initials: A
authors.lastname: Dean
authors.affiliation: Senior Lecturer, Department of Allied Health Professionals, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Willis
mesh_terms: D002985:Clinical Protocols; D003142:Communication; D004645:Empathy; D006801:Humans; D010817:Physician-Patient Relations; D014342:Truth Disclosure
keywords: Breaking bad news; Communication; Information; Protocol; Support