​​​​The Difficult Conversations program aims to provide you with skills to support patients and families through difficult conversations.

Difficult conversations include:

  • Breaking bad news (diagnosis, poor prognosis)
  • Incident disclosure (advising of an adverse event)
  • Responding to challenging behaviours/encounters (behaviours that impact/disrupt patient care, negatively impact staff or other patients, including harassment, treatment non-adherence)​

Pro​gram Details

The program is designed as a 'flipped classroom' where theoretical learning is done in advance through this course in preparation for an in-person practice opportunity.​

The program includes the following 4 elements:

  1. eLearning: The 5 modules in this program provide you with a range of skills and best practices for handling difficult conversations. On this page: See the list of eLearning modules »
  2. Reflective Discussion: Participate in small group discussions with the people you will practice with. Watch 2 brief real patient videos created just for you in this course. Respond to some questions and see where your group takes it.
  3. Recommended Readings:On this page: ​See the list of recommended readings​ »
  4. In-Person Practice Opportunity: Observe and participate in difficult scenarios with standardized patient actors.
    A fully virtual version of Difficult Conversations in Cancer is scheduled for Summer 2020.
    When: Tuesday, July 21, 2020 from 8:30am - 1:00pm


Complete 5 short eLearning modules:

  1. Communication skills: Uses interactive scenarios to demonstrate some techniques for building rapport with your patients.
  2. Speaking in plain language: Helps you to consider how to use language that your patients will understand and recall.
  3. Breaking bad news: Teaches the specifics of how to break bad news in a way that will minimize the negative experience.
  4. Incident disclosure: Provides background on incident disclosure and teaches the best way to communicate an event such as a medical error.
  5. Resilience and coping: Teaches techniques that providers can use to build resilience and coping mechanisms to help combat burnout and compassion fatigue.


​Recommended Readi​​ngs

​Breaking Bad News & Challenging Communicatio​​ns in Cancer Care

  • Back, A.L. (2003). Hope for the best, and prepare for the worst. Annals of Internal Medicine. 138(3): 439-444.
  • Back, A.L. et al. (2005). Approaching difficult communication tasks in oncology. Cancer Journal for Clinicians. 55:164-177.
  • Back, A.L. & Arnold, R.M. (2006). Discussing prognosis: "how much do you want to know?" Talking to patients who do not want information or who are ambivalent. Journal of Clinical Oncology. 24(25):4214-4217.
  • Back, A.L. et al. (2008). Communication about cancer care near end of life. Cancer. 113:7 (Supp, 1897-1910).
  • Baile, W., et al. (2000). SPIKES – a six-step protocol for delivering bad news. Oncologist. 5(4): 301-311.
  • Bernacki, R.E., & Block, S.D. (2014). Communication about serious illness care goals: a review and synthesis of best practices. JAMA Internal Medicine. E1-E10.
  • CETL (2010). SPIKES - The Six-Step Protocol for Delivering Bad News. A Training Resource for Healthcare Professionals.
  • Drummond, D. The Universal Upset Person Protocol (UUPP). www.TheHappyMD.com.
  • Dunniece, U., & Slevin, E. (2000). Nurses' experiences in being present with a patient receiving a diagnosis of cancer. Journal of Advanced Nursing. 32(3): 611-618.
  • Faulkner, A. (1998). ABC of palliative care: communication with patients, families, and other professionals. British Medical Journal. 316: 130-132.
  • Thorne, S.E., Bultz, B.D., & Baile, W. F. (2005). Is there a cost to poor communication in cancer care?: a critical review of the literature. Psycho-Oncology, 14: 875-884.


  • Bonney, W. (2014). Medical errors: moral and ethical considerations. Journal of Hospital Administration. 3(2): 80-88.
  • Canadian Medical Protective Association. (2008) Communicating with your patient about harm: disclosure of adverse events. CPMA.
  • Canadian Patient Safety Institute. (2011). Canadian Disclosure Guidelines: being open with patients and families. CPSI.


  • Nedrow, A., Steckler, N.A., & Hardman, J. (2013). Physician resilience and burnout: can you make the switch? Family Practice Management. 25-30.
  • Zwack, J., & Schweitzer J. (2013). If every fifth physician is affected by burnout, what about the other four? Resilience strategies of experienced physicians. Academic Medicine. 88:382-389.
Last reviewed: 7/19/2020
Last modified: 7/20/2020 5:39 AM