Breaking bad news and serious-illness communication — branching viva

Opening (candidate)

I would treat this as a SPIKES conversation, not a result handover. First I would prepare: a private room, a trained interpreter, the right people including the child's nurse and, where possible, the treating surgeon or oncologist, and enough uninterrupted time. Then I would assess what the family already understands and how much they want to hear before sharing the diagnosis, responding to emotion with NURSE, and arranging follow-up. [1] [3]

Branch A — Definition and framework

Examiner: What is SPIKES, and why a protocol at all? [1]

Candidate: SPIKES is Setting, Perception, Invitation, Knowledge, Empathy, Strategy — a six-step structure for delivering bad news. The protocol exists because unprepared disclosure causes shock, information loss, and loss of trust; structure protects the family and the clinician. [1] [2]

Branch B — The child in the room

Examiner: The 7-year-old is verbal and present. How do you involve them? [3]

Candidate: I would address the child developmentally — concrete, truthful language about what their body is doing and what treatment will feel like — correcting magical thinking and inviting questions, while coordinating a consistent message with the parents. I would not exclude the child by default. [3] [10]

Branch C — Direct prognostic question

Examiner: The parent asks, 'Will my child be cured?' [8]

Candidate: I would answer honestly with calibrated uncertainty, acknowledging what is and is not known, and explore their hopes. I would avoid false precision and false reassurance, and move hope toward what is achievable while staying present with them. [8]

Branch D — Language access

Examiner: The family speaks limited English. Your interpreter is unavailable for an hour. Wait, or proceed? [14]

Candidate: I would wait for a trained interpreter rather than use a family member or the child. Serious news delivered without accurate language access is unsafe. I would offer a brief, supportive holding message and confirm a time. [3] [14]

Branch E — Failure mode

Examiner: A colleague already told the parents 'it's nothing to worry about.' [1]

Candidate: I would avoid openly contradicting my colleague in front of the family. I would acknowledge the confusion, gently correct with the new information, and align the team afterwards so the family hears one consistent message. [1] [3]

Close

Confirm understanding with teach-back, leave a written summary and a named next contact, and arrange a team debrief. [1] [3]