This study builds upon existing protocols for breaking bad news (BBN), and offers an interaction-based approach to communicating comfort to patients and their families. The goal was to analyze medical students' (N = 21) videotaped standardized patient BBN interactions after completing an instructional unit on a commonly used BBN protocol, commonly known as SPIKES. Through "post hoc" interviews with the medical student, standardized patients, and faculty member for the unit, we revealed discrepancies between clinicians' idealized BBN interactions and their actual bad news delivery enactment. COMFORT, is an acronym for the seven empirically derived, resulting core communication competencies that seek to overcome some of the communicative constraints to effective BBN experienced by clinicians and patients. COMFORT is built around the fundamental principles of interaction adaptation theory (Burgoon, Stern, & Dillman, 1995), which in this case is applied to communication in medical encounters.