Breaking Bad News

Practise delivering serious, life-changing news using the SPIKES protocol and responding to emotion with NURSE. Meet a patient who has come in for results, give a difficult diagnosis clearly and humanely, and stay with the feelings instead of rushing to fix.

What you practise

• Deliver serious, life-changing news clearly and humanely using the six steps of SPIKES.
• Find out what the patient already understands, and how much they want to know, before giving information.
• Give a warning shot and a short, plain-language headline, then pause and let the news land.
• Respond to strong emotion with NURSE before moving on to information or plans.
• Summarise, agree on concrete next steps, and check understanding without false reassurance.

Who you can meet

• Birgitta, 61 — Recently retired teacher who has come in alone to hear test results for a cough, tiredness, and weight loss. She is hoping it is a stubborn infection and does not yet know she has cancer.
• Karin, 48 — Recently divorced bookkeeper with long-standing health anxiety who has come in alone to hear results for a breast lump. She is convinced it is "just her anxiety playing tricks" and is bracing to be told, once again, that she is overreacting. She does not yet know she has cancer.
• Göran, 56 — A civil engineer who has come with his wife Annika to hear biopsy results after blood in his urine and a cystoscopy. He receives the news with unnerving calm — "I understand. What is the next step?" — while Annika is visibly distraught. The challenge is recognising that his composure is a wall, not strength, and helping him make contact with what he feels before rushing to plans.
• Annika, 54 — Göran's wife. She has barely slept since the cystoscopy. She carries the fear he refuses to feel — tearful, searching, reaching for him. She is not hysterical; she is a normal person terrified for her husband.

What the feedback looks at

• Setting up
• Assessing perception
• Obtaining invitation
• Giving knowledge
• Addressing emotions (NURSE)
• Strategy & summary
• Overall communication

Rated against: Dimensions follow the six-step SPIKES protocol (Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. "SPIKES — A Six-Step Protocol for Delivering Bad News: Application to the Patient with Cancer." The Oncologist 2000;5:302-311) and the NURSE empathic responses (Back AL, Arnold RM, Baile WF, Tulsky JA; VitalTalk). The anchor wording here is PsychBase's own, adapted with citation — nothing is reproduced from either source, and neither author nor publisher endorses or certifies this tool. Scores are generated by an AI reviewer from the session transcript. They are a practice aid, not a validated assessment: SPIKES and NURSE assume a trained human observer, and an AI score is not equivalent to one. Scores never gate progression.

This lab is for clinical training. The patient is generated by an AI language model from a written case; no real patient and no patient data are involved. Browsing is open; starting a session needs a free account.