Delivering bad news to patients and their families can be one of the most daunting tasks we are called upon to do as care providers. Many clinicians feel embarrassed and unsure as to how to proceed. This chapter provides a framework for how to navigate these difficult situations. The SPIKES protocol offers a validated, six-step approach which is easily learned and implemented. Like other skills, practice prior to a first encounter with a patient is helpful. A smooth transition from therapeutic management to supportive care near the end of life is essential for the care team and their patient. Planning to be done in advance of the end of life is addressed as is the concept of a good death, including information on hospice and medically aided dying.