Breaking bad news stations are among the most demanding in PLAB 2. The SPIKES framework helps you stay structured while remaining genuinely patient-centred.
How to structure it (SPIKES)
- Setting: ensure privacy, sit down and give the conversation your full attention.
- Perception and Invitation: find out what the patient already knows and how much they want to know.
- Knowledge: give a brief warning shot, then the news clearly and simply.
- Emotions: pause, allow silence, and acknowledge feelings before moving on.
- Strategy: agree clear next steps and check understanding.
Common pitfalls
- Delivering the news without a warning shot.
- Filling silence with information instead of allowing emotion.
- Rushing to a plan before the patient is ready.
Examiners reward warmth, a clear warning shot, well-used silence, and a sensitively agreed plan.
More breaking bad news stations
Practise this station with an AI patient
Run the full breaking bad news: breast cancer station consultation against the clock with a realistic AI simulated patient, then get structured PLAB 2 feedback.
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