Skip to Content

Basic Principles

In this section, you'll learn about four useful communication strategies:

  • CLASS is the fundamental protocol for all clinical interviews.
  • EVE is a special strategy to use inside of other protocols when responding to emotions within any type of interaction.
  • SPIKES is a protocol to use when you must break bad news.
  • CONES is a variation of the SPIKES protocol that is useful for error disclosure.

You can then explore each of these strategies in depth. We have included explanations of what they are and how they work, as well as video vignettes that show a physician (Dr. Robert Buckman) actually using them in clinical scenarios. The patients in these encounters are professional "standardized patient" actors, but the vignettes are unscripted, and depict situations that arise not uncommonly in the practice of oncology.

      Introduction to basic principles: CLASS-EVE-SPIKES-CONES (11:44) - This video will provide you with a brief overview of basic communication techniques

These videos will provide you with an expanded discussion and illustration of both basic principles (CLASS) and strategies for giving bad news (SPIKES) and error disclosure (CONES).

CLASS - in depth (5 videos - 57 minutes)
SPIKES - in depth (5 videos - 33 minutes)
CONES - in depth (2 videos - 11 minutes)

Dr. Robert Buckman discusses techniques for effectively using non-verbal communication. You will find this video illustrates in greater detail how paying attention to non-verbal behavior in the clinical encounter can help you with the messages that you send to others.

      Non Verbal Communication - In Depth (22:52)

CME Credit Available

Certain material on this Web site is available for Continuing Medical Education (AMA PRA Category 1 CreditTM in medical ethics and/or professional responsibility) through the University of Texas M. D. Anderson Cancer Center. To obtain credit you must use the “Obtaining Continuing Education Credit” link on the left. You also have the option of watching the video from this page without applying for credit. To download or subscribe to these videos, please go to M. D. Anderson on iTunes U. 

I*CARE on iTunes U

Anyone wishing a copy of the videos may download or subscribe to the videos at
M. D. Anderson on iTunes U.

Note: You must have iTunes software (a free download from Apple) installed to launch this link. (Page will open in a new browser window. M. D. Anderson does not endorse external sites.)


© 2009 The University of Texas M. D. Anderson Cancer Center