As a Doctor, How Do You Tell Your Patient That They Cannot Live Any Longer Due To Their Illness?

This question was originally posted on Quora.com and was answered by Zonghao Pan, MBBS Medicine, Wenzhou Medical University (2020)

There is a protocol named SPIKES protocol for delivering bad news.


6-step protocol that can help make the situation easier follows:

Step 1: Start off appropriately in a private setting with the support that the patient desires (e.g., family, a friend). Make sure patient sit down or lie on the bed for possible vasovagal syncope.

Step 2: Determine how much the patient already knows

"what is your understanding about what might be causing your back pain?"

Step 3: Find out the level of information that the patient wants

"Would you like me to tell you the full details of the diagnosis?" or "Your condition is serious; how much would you like to know about it?"

Step 4: Share the information in a clear language, not using medical jargon. Reinforce and clarify information, provide education, and answer questions.

Step 5: Respond to the patient's feelings.

Step 6: Establish a plan, summarize the conversation, and make a contract for future discussions/treatments.

If estimated life expectancy less than 6 months, discuss the option of hospice care with the patient and his family. Establish the goal of care (GoC) is important. To the cases where patient suffering to death, GoC might be pain control. Please keep family well informed.

Ref: USMLEWorld

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