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Editor-in-Chief, Robert Amdur, MD, discusses structured formats for delivering bad news to patients. The discussion begins with an explanation of the SPIKES protocol and a recent analysis identifying five behavior practices that enhance physician communication in clinical encounters. The discussion ends with review of a paper published in the May 2023 issue of PRO titled "Serious Illness Communication Training Among Radiation Oncology Residents" (2023, Issue 3, May/June, PMID: 36526246). This paper demonstrates the use of a highly sophisticated education program involving simulated patients, didactic lectures, and independent evaluators to create a structured curriculum to teach and evaluate serious illness communication skills of radiation oncology residents.