Giving Bad News.

In the practice of oncology, a number of clinical situations require bad news to be given to patients and families. SPIKES (setting, perception, invitation for information, knowledge, empathy, summarize and strategize) is a skills-based, best-practices approach to giving bad news. ••Although not formally tested in clinical trials, the communication skills it encompasses have been associated with positive patient outcomes. SPIKES is best viewed as a flexible guideline to help physicians address individual patient and family needs in a patient-centered manner.