Core Modules

module 2 | Activity 4: Communication principles

Effective and efficient communication is crucial for providing care and support to people affected by life-limiting illness.[1, 2] However, some people are not accustomed to discussing personal psychological issues and can find these conversations difficult. There are some general communication strategies that help facilitate discussion about existential and psychological concerns, and demonstrate respect for the person’s individuality.

The PREPARED communication framework outlines key strategies that can be used when communicating with a person with a life-limiting illness, their family and carers.

The PREPARED communication framework

P Prepare for the discussion, where possible
R Relate to the person
E Elicit preferences from the person and their caregiver/s
P Provide information tailored to the needs of both the person with a life-limiting illness and their families and carers
A Acknowledge emotions and concerns
R (foster) Realistic hope (e.g. peaceful death, support)
E Encourage questions and further discussions
D Document
Source: Clayton, J., Hancock, K., Butow, P., Tattersall, M. & Currow, D. (2007). Clinical practice guidelines for communicating prognosis and end-of-life issues with adults in the advanced stages of a life-limiting illness, and their caregivers. MJA, 186 (12), S77-S108. Retrieved September 15, 2010, from issues/186_12_180607/cla11246_fm.html.[3]
Reproduced with permission.

The PREPARED communication framework in clinical practice

The SPIKES communication framework

The SPIKES Protocol was developed to assist healthcare professionals with breaking bad news. Effective communication when dealing with bad news can enhance the understanding of prognosis and treatment options, and the person’s adjustment to their situation.[2] THE SPIKES steps can complement the PREPARED framework by assisting with the four most important objectives of breaking bad news:

  1. Gathering information
  2. Transmitting medical information
  3. Providing support
  4. Eliciting the person’s collaboration in developing a strategy or treatment plan for the future.

Although some of the steps of SPIKES are similar to the steps in PREPARED, SPIKES concentrates on delivering bad news (such as the initial diagnosis), while PREPARED focuses on the holistic support of the person and their family throughout their illness and can be used to frame discussions in a range of palliative contexts.[4-7]

S Setting up the conversation
P Assessing the person’s perception
I Obtaining the person’s invitation
K Providing knowledge and information to the person
E Addressing the person’s emotions with empathic responses
S Strategy and Summary

The SPIKES communication framework in clinical practice

Paramedic-Specific ContentParamedic Content

Adapted SPIKES communication framework for paramedics


It is important to note that these frameworks are guides only and not prescriptive checklists for having a conversation with a person affected by a life-limiting illness. Use the steps in the frameworks to guide your interactions and to assist you in planning and preparing for difficult conversations.

Communication resources for under-served groups

A key aspect of effective communication involves gaining an understanding of the barriers that are experienced by many people in accessing palliative care. Recent reports have highlighted that there are various groups of people in our communities who experience barriers to the provision of palliative care, referred to as under-served population groups.[8]

These resources from the PEPA project aim to support communication in these groups:

  1. Consider your experience of discussing existential and psychological concerns with people.
    • What aspects of communication are you most comfortable with in this area?
    • What aspects of communication do you find challenging?
    • What are some key learnings you have made in leading or hearing such conversations?
    • What might you change or improve within future conversations?

If you have not experienced this kind of difficult conversation, reflect on a discussion you observed within your student context or review the case study video ‘Michelle’s story – Receiving distressing news’. Select one of the tools described in this section (ie, PREPARED or SPIKES) to guide your reflections on your observations of these interactions.

  1. Using the principles described in this section, outline:
    • What communication strategies you most commonly use
    • What additional strategies you could implement.
  1. CareSearch. Communication. 2018  [cited 2018 12/07/2018]; Available from:
  2. Therapeutic Guidelines Ltd, Communicating with the patient in palliative care. 2019: Melbourne.
  3. Clayton, J.M., et al., Clinical practice guidelines for communicating prognosis and end-of-life issues with adults in the advanced stages of a life-limiting illness, and their caregivers. Medical Journal of Australia, 2007. 186.
  4. Kaplan, M., SPIKES: a framework for breaking bad news to patients with cancer. Clin J Oncol Nurs, 2010. 14(4): p. 514-6.
  5. Rosenzweig, M.Q., Breaking bad news: a guide for effective and empathetic communication. The Nurse practitioner, 2012. 37(2): p. 1-4.
  6. Monden, K.R., L. Gentry, and T.R. Cox, Delivering bad news to patients. Proceedings (Baylor University. Medical Center), 2016. 29(1): p. 101-102.
  7. Ferreira da Silveira, F.J., C.C. Botelho, and C.C. Valadão, Breaking bad news: doctors  skills in communicating with patients. Sao Paulo Medical Journal, 2017. 135: p. 323-331.
  8. Commonwealth of Australia – Department of Health, 2020, Exploratory Analysis of Barriers to Palliative Care – Summary Policy Paper.