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# Interviewing in special situations: interpreters and breaking bad news

- Topic

Speaking through an interpreter or breaking bad news takes preparation, plain language and attention to the patient's emotions.

Updated 2026-11-01

## Key points

- SPIKES: set up the setting, explore what the patient knows, ask how much they want to know, give the knowledge, respond with empathy, and summarise with a plan.
- Information is given in small pieces, without jargon, checking understanding.
- Ask-tell-ask: explore first, then give the brief message, then check what was understood.
- A professional interpreter is preferred; relatives, and above all children, should not act as interpreters.
- With an interpreter, look at and speak to the patient in the first person ('Where does it hurt?'), not to the interpreter.

## What it is

Some interviews need their own techniques: with patients who speak another language (in Colombia, for example, Indigenous communities or migrants), with Deaf patients, and when breaking bad news. With an interpreter the clinician speaks directly to the patient, in short sentences. For bad news, protocols such as SPIKES order the conversation in six steps, and an empathic response to emotion matters as much as the information.

## Key facts

- Check understanding: ask the patient to explain in their own words what they understood.
- Give neither false hope nor take all hope away: the information is honest and comes with a plan.
- Respect the patient's culture and language; Colombia has more than 60 native languages.
- Record what was told, to whom, who was present and whether an interpreter was used.

## Step by step

- Prepare: a private room, sit down, silence the phone, invite whoever the patient wishes.
- Explore: 'What have you been told so far about your tests?'
- Invite: 'Would you like me to explain all the details, or would you rather we talk about the main points?'
- Warn: 'I'm sorry to tell you that the results are not what we hoped.'
- Inform in short sentences and pause; allow silence.
- Respond to emotion: 'I can see this is very hard for you.'
- Summarise and agree the next step: 'I'll explain what comes next, and we will not leave you on your own.'
- With an interpreter: brief them beforehand, seat them beside the patient and speak to the patient in short sentences.

## Memory aid

Ask before you speak; after you speak, stay silent: silence leaves room for emotion.

## Test yourself

Think of the answer, then tap the question to see it.

## What are the six steps of the SPIKES protocol?

Setting, perception of the patient, invitation (how much they want to know), knowledge, empathy, and summary with a strategy.

## Why should a relative not be used as an interpreter?

They may leave out or soften information, change the meaning and feel uncomfortable with hard topics; it also affects confidentiality.

## Whom does the clinician look at and address when working with an interpreter?

The patient, in the first person and in short sentences; the interpreter sits beside or slightly behind the patient.

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## Related

- [The medical interview: rapport, open questions and listening](https://durgical.com/en/clinical-exam/the-medical-interview-rapport-open-questions-and-listening/)
- [The clinical history: its parts and their order](https://durgical.com/en/clinical-exam/the-clinical-history-its-parts-and-their-order/)
- [From findings to diagnosis: problem list, differential and SOAP note](https://durgical.com/en/clinical-exam/from-findings-to-diagnosis-problem-list-differential-and-soap-note/)

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Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.

Sources: [Communication in Cancer Care (PDQ®)–Health Professional Version](https://www.cancer.gov/about-cancer/coping/adjusting-to-cancer/communication-hp-pdq) (U.S. National Cancer Institute, 2025); [2.4 Therapeutic Communication - Fundamentals of Nursing | OpenStax](https://openstax.org/books/fundamentals-nursing/pages/2-4-therapeutic-communication) (OpenStax, Rice University, 2024).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/clinical-exam/interviewing-in-special-situations-interpreters-and-breaking-bad-news/