Breaking bad news and serious-illness communication — formative SAQs

SAQ 1 (10 marks)

A 6-year-old is admitted with pallor and bruising; the blood film shows blasts. Both parents are present and waiting to hear the results. [1]

1. Name and define the six steps of the SPIKES protocol. (4) [1]
2. Describe how you would prepare the setting before sharing this news. (3) [1] [3]
3. Describe how you would respond to emotion once the news is shared, and name a structured tool for doing so. (3) [1] [2]

Model answer

SPIKES: Setting (private space, time, right people, interpreter); Perception (what they already know); Invitation (how much they want now); Knowledge (warning shot then plain-language headline in chunks); Empathy (respond to emotion); Strategy and summary (plan, written summary, follow-up). [1]

Prepare: a private room, both parents seated at eye level, enough uninterrupted time, phones away, tissues and water, and a trained interpreter if needed; confirm the facts and align the team beforehand. [1] [3]

Respond with NURSE (Naming, Understanding, Respecting, Supporting, Exploring); tolerate silence rather than filling it; do not continue information before acknowledging the emotion. [1] [2]