Responding to Anger

Disclose Serious News:

When you need to give information that no one wants to hear, more information may not be better. Check out our 5-step talking map to guide your patient.

We know that this topic is often named ‘breaking bad news’. But what the research shows us is that clinicians can feel their job is done when the news is delivered, when patients feel the most important part of the conversation is to hear about what they can do about their illness. And the imagery of ‘breaking’ and the acronym “SPIKES” seem to reinforce, if unintentionally, the sense that the clinician’s job involves force.

So we’ve simplified our map for disclosing serious news, to GUIDE. For us this metaphor evokes how clinicians can really be helpful. You can find a one-page version of the map here or in our iOS app, Vital Talk. If you like SPIKES, you can find a one-pager for that here too. 

What’s different about GUIDE? First we’ve dropped the “invitation” step—in our experience, clinicians tend to get bogged down in trying to forecast the news, and in our studies, patients disliked it. Second, we’ve changed the last step to “Equip”—because serious news is usually the first step to a new chapter of medical care.  So clinicians need to equip the patient for what will happen next—a test, a consultant, a medication, a procedure. And in our medical systems, the clinician who disclosed the news will often not be at the next step for continuity.