How would you break bad news?

This question tests your communication, empathy, professionalism, and sympathy skills all at once, so your answer needs to clearly demonstrate each of these qualities rather than simply listing steps. A well-recognised framework for structuring this kind of answer is the SPIKES protocol, which is widely used in both medical and dental training for breaking bad news.

SPIKES stands for:

• S — Setting

Ensure the patient is sat down and comfortable, and remove any distractions from the environment — for example, making sure equipment like the aspirator isn’t making noise in the background. A calm, private setting shows respect for the seriousness of the conversation.

• P — Perception

Before delivering the news, gently gauge what the patient already understands or expects. This helps you pitch the conversation at the right level and avoid overwhelming or confusing them.

• I — Invitation

Ask the patient if they have any questions, or how much detail they’d like. This gives them some control over the conversation and respects their autonomy.

• K — Knowledge

Deliver the necessary information clearly and without jargon. Avoiding technical language is especially important here, as confusion on top of distressing news can make the situation far harder for the patient to process.

• E — Emotions

Stay attentive to the patient’s emotional response throughout. If they become upset while you’re explaining their diagnosis, acknowledge this directly rather than pushing on with information. It may be appropriate to pause once or twice, giving the patient space to process what they’ve heard. The goal is to make the patient feel genuinely seen and supported, not just informed.

• S — Strategy and Summary

Close the conversation by explaining what happens next. Reassure the patient that you are referring them to the appropriate specialist, and emphasise that they will continue to be supported and helped going forward.

Suggested structure for this question

• Introduce SPIKES by name early in your answer, showing the interviewer you’re aware of a recognised, structured approach to this sensitive scenario — this immediately signals professionalism and preparation.
• Walk through each stage in order, briefly explaining what it involves and why it matters, rather than just listing the letters.
• Weave in empathy throughout, not just in the “Emotions” stage — for example, mention tone of voice, body language, and patience at multiple points.
• Emphasise clarity over completeness — explain that the priority is the patient understanding and feeling supported, not delivering every clinical detail at once.
• End on reassurance and continuity of care — showing that breaking bad news isn’t just about the moment itself, but about ensuring the patient knows they won’t be left to deal with it alone.