The breaking-bad-news station
- OSCE station
In this station the student tells an actor playing a patient serious news, such as a cancer diagnosis, with honesty, empathy and a clear plan.
What it is
The bad-news station tests whether the candidate can share serious news, such as a cancer diagnosis, a poor prognosis or a failed treatment, in a way that is honest, kind and structured. The widely used SPIKES protocol gives six steps: Setting up the interview (privacy, sitting down, time, a companion if wanted), Perception (what the patient already knows or suspects), Invitation (how much the patient wants to know), Knowledge (giving the news clearly, with a warning shot and without jargon), Emotions (recognising and responding to the reaction with empathy) and Strategy and summary (a plan and the next steps together). The standardised patient is trained to react: silence, tears, anger, denial or a flood of questions. Examiners look for silence used well, empathic statements, no false reassurance, information in small amounts, checking understanding, and a plan that leaves the patient with support and a next appointment. The news itself should be said in plain words; euphemisms leave the patient unsure what was meant.
What is assessed
- Setting: privacy, seated at eye level, no interruptions, enough time, a companion if the patient wishes.
- Perception: open questions about what the patient has understood so far.
- Invitation: ask how much detail the patient wants now.
- Knowledge: a warning shot, then clear words without jargon, and pauses to check understanding.
- Emotions: name and acknowledge the emotion, and give time before moving on.
- Strategy and summary: next steps, support available, questions, and when you will meet again.
How to do it (and why)
- Prepare the room, sit down, silence the phone and ask who the patient would like present — the setting shows respect.
- Ask what they know about why the tests were done — you start from their understanding, not yours.
- Ask how much they want to hear today — patients differ, and respecting it is marked.
- Give a warning shot: «I am afraid the results are not what we hoped» — it prepares the patient for the news.
- Say the news in plain words and pause — clarity and silence let the information land.
- Acknowledge the emotion you see and stay with it — empathy before information is the core of the station.
- Check understanding and answer questions honestly — avoid false hope and avoid overload.
- Agree a plan, offer support and arrange follow-up — the patient should not leave feeling alone.
Mistakes that cost marks
- Giving the news immediately without finding out what the patient knows.
- Using euphemisms or jargon so the patient is unsure what was said.
- Filling every silence with more information.
- False reassurance («It will be fine») or a premature exact prognosis.
- Ignoring the emotion and pressing on with the treatment plan.
- Ending without a plan, support or follow-up.
Self-check list
- I set up a private, seated, unhurried conversation.
- I asked what the patient already knew.
- I asked how much information they wanted.
- I gave a warning shot and then the news in plain words.
- I allowed silence and responded to emotion with empathy.
- I checked understanding and answered honestly.
- I agreed a plan, support and follow-up.
Test yourself
Think of the answer, then tap the question to see it.
What do the six letters of SPIKES stand for?
Setting up the interview, Perception, Invitation, Knowledge, Emotions (responding with empathy) and Strategy and summary.
Why is the patient's perception explored before the news is given?
It shows what the patient already knows or fears, so the news can be pitched to their understanding and misunderstandings corrected.
What is a warning shot when breaking bad news?
A short sentence that prepares the patient, such as saying the results are not what was hoped, before the news is given in plain words.
How should the candidate respond when the patient cries after hearing the news?
Pause, allow silence, acknowledge the emotion with an empathic statement and offer time, before giving any more information.
Elsewhere in DurgiPedia
- Breaking bad news: the SPIKES protocol
- Interviewing in special situations: interpreters and breaking bad news
Connections
Educational content; it does not replace supervised hands-on training, your institution's protocols or a prescriber's order. A procedure is learnt with a teacher and done only once you are trained to do it.
Sources: SPIKES: a six-step protocol for delivering bad news: application to the patient with cancer (Baile WF, Buckman R, et al.) (The Oncologist, Oxford University Press, 2000); Set Up and Execution of an Effective Standardized Patient Program in Medical Simulation (StatPearls (NCBI Bookshelf), 2023).
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Representative model, for educational purposes only.