Promoting Excellence : SPIKES: Breaking Bad News

SPIKES: Breaking Bad News

A handout that presents a six step model for communicating serious information to patients using SPIKES, an acronym for setting, perception, invitation, knowledge, empathy, and summary.

Educational Tools - Clinician Education

The Amyotrophic Lateral Sclerosis Workgroup of
Promoting Excellence in End-of-Life Care
Hiroshi Mitsumoto, MD, Chair

Hiroshi Mitsumoto, MD
Chair, ALS Workgroup
Eleanor & Lou Gehrig MDA/ALS Center
College of Physicians & Surgeons
Columbia University Neurologic Institute
New York, NY
[email protected]

Recommendation of the workgroup for use of this instrument:
Used by the clinician as a guide for communicating serious information to the ALS patient.

breaking bad news, communication, SPIKES, ALS

To use this tool:
You may print and copy this tool for your own use from the website. Please credit source.

Developed by Robert Buckman, MD, Associate Professor of Medical Oncology, University of Toronto. Modified from version: Sandrick, K. "Codified principles enhance physician/patient communication." Bulletin of the American College of Surgeons, 83(11):13-17, 1998

To view this tool:
ALS Appendix C, p 18 (pdf PDF 1.3 MB / 87 pages)

Posted March 10, 2005

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Promoting Excellence in End-of-Life Care was a national program of the Robert Wood Johnson Foundation dedicated to long-term changes in health care institutions to substantially improve care for dying people and their families. Visit for more resources.

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