23 | Delivering Difficult News with Cory Edgar, DMSc, PA-C

23 | Delivering Difficult News with Cory Edgar, DMSc, PA-C

Host: Toni Dobson Guest: Corey Edgar DMSc, PA-C 🩺 — oncology and bone marrow transplant clinician, born and raised in Florida, whose doctoral work focused on delivering difficult messages

📝 Episode Summary

Delivering bad news is not a "soft skill" — it is a core clinical skill that can be learned, practiced, and improved. In this episode, Toni sits down with Corey Edgar to walk through the SPIKES protocol, a structured framework for difficult conversations. Corey breaks down each step with practical ED examples, explains why the warning shot and the pause matter so much, and reminds us that bad news is not only cancer or death. Anything that changes a patient's or family's anticipated future counts — which means most of us deliver bad news on every shift.

🔑 Key Takeaways

• 💪 Communication is a learnable skill. Practice it and let others watch and give you feedback.
• 🎯 "Warning shot, then be quiet." If you remember one thing, remember this.
• ⏳ Silence will feel longer than it is. Five seconds of quiet with emotional tension feels like forever — give your patient that space anyway.
• 🛑 When emotion rises, the information download stops. The visit and the engagement continue, but the data dump does not.
• 🤔 Not knowing everything is okay. Name what is known, what is unknown, and what comes next.
• 🧩 Bad news is defined by the recipient, not by us. A new type 1 diabetes or celiac diagnosis may be very manageable medically, but it still changes a family's anticipated future.

⏰ Timestamps

• 00:00 — Intro
• 00:16 — Meet Corey Edgar
• 00:36 — Why "soft skills" are actually core clinical skills
• 01:05 — The data: malpractice, satisfaction, adherence, and outcomes
• 01:56 — Communication as a learnable skill and an introduction to SPIKES
• 02:22 — S: Setting
• 02:54 — P: Perception
• 04:06 — I: Invitation
• 05:30 — SPIKES as a procedure: the prep work
• 05:51 — K: Knowledge and the warning shot
• 06:56 — Example: the abdominal pain case
• 07:48 — The power of the pause
• 09:03 — E: Emotion and empathy
• 10:30 — S: Summary and strategy — naming uncertainty
• 11:38 — Toni's "too calm" story and the missed warning shot
• 12:00 — "Warning shot, then be quiet"
• 12:32 — What counts as bad news
• 13:29 — Wrap-up
• 13:38 — Disclaimer

⚖️ Disclaimer

Any opinions expressed on today's podcast are solely those of the speaker and do not reflect the opinions or policies of any employer or hospital system. In many states, advanced practice providers work collaboratively with physicians. Always consult your physician leader when appropriate. Any cases discussed on this podcast have been de-identified, and details have been changed or omitted to protect patient privacy. Some cases may also represent composites of our clinical experiences, and any resemblance to a specific individual beyond the educational context is unintentional.

This podcast was designed for medical education purposes only. Its speakers have made every effort to provide the most current and evidence-based information. However, that should never replace one's own effort to validate current evidence-based practice before implementing a plan of care. Any pathway or algorithm that we may have discussed may not reflect those of your healthcare system. Please be aware that there may be changes based on your geographic location or current employer site. This podcast was not designed in any way to provide medical advice or treatment plans for patients and their families. If you have a medical concern or an emergency, please be seen by a local medical provider or call 911 for assistance.