Review Article

How to break bad news?: Systematic Review

Sam Hajialiloo Sami, Azra Izanloo , Amir Mohamad Arefpour, Masoud Mirkazemi

Sam Hajialiloo Sami
Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, IR Iran.

Azra Izanloo
Razavi Cancer Research Center, Razavi Hospital, Imam Reza International University, Mashhad,Iran. Email:

Amir Mohamad Arefpour
Firrozgar Hospital,Iran University of Medical Sciences, Tehran, IR Iran.

Masoud Mirkazemi
Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, IR Iran.
Online First: December 31, 2018 | Cite this Article
Hajialiloo Sami, S., Izanloo, A., Arefpour, A., Mirkazemi, M. 2018. How to break bad news?: Systematic Review. The Cancer Press 4(1,2,3,4): 13-24. DOI:10.15562/tcp.69


We conducted a systematic review of studies that focus on existing protocols for oncologists and other physicians who are in touch with cancer patients.


We searched all internationally published articles on the introduction of a protocol as the guideline. To this purpose, we did a thorough search of Pubmed and Cochrane Collaboration Library databases and reviewed all articles from 2010 to 2017.


We introduced 7 papers from 7 countries and evaluated their proposed protocols. A primary protocol called SPIKES had been discussed in most studies. This protocol emphasized the six steps of setting, perception, invitation, knowledge, empathy and summary.


 BBN is a balanced action that requires oncologists and other specialists to consistently adapt to its different criteria. Developing the ability to personalize and adapt to therapeutic treatment with respect to communications can be a major step forward in the training and exercises that physicians receive in connection to communication skills.


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