Resident Doctors' Experiences in Breaking Bad News: The Level of Using Spikes Protocol and Related Factors

Year 2024, , 59 - 65, 14.08.2024

Banu Çiçek Dilfiruz , Yasemin Çayır , Esra Çınar Tanrıverdi

https://doi.org/10.5281/zenodo.13310409

Abstract

ABSTRACT
Objective: This study aimed to determine assistant doctors' experiences of giving bad news, their use of the SPIKES protocol, and effective factors.
Methods: The study was conducted at Atatürk University Faculty of Medicine between September-December 2017 with 232 assistant doctors. The participants' experiences of delivering bad news were assessed using a questionnaire based on the SPIKES protocol. The questionnaire, consisting of 20 questions on a five-point Likert scale, covered six key areas: environment, perception, invitation, information, affect, and plan-summary. Factors that could affect participants' methods of breaking bad news were questioned. Significance level was accepted as P<.05.
Results: Of the participants, 57.3% (n=133 were male, 57.3% (n=133) were married, and 70.3% (n=163) were working in internal sciences. Mean age was 29±3.5 years, and mean total working time was 4.5±3.3 years. 64.7% (n=150) had no pre-graduation training in giving bad news, and 90.9% (n=211) had no post-graduation training. 38% felt competent, 35.8% found difficulty in giving bad news. 60.8% devoted enough time to interviews, 24.1% arranged quiet rooms, and 43.1% used warning sentences, and 75.9% empathized, 69% had quiet rooms during interviews. All participants allowed their emotions, and 84.9% made eye contact. Male participants introduced themselves more frequently than females before interviews (P<.05).
Conclusion: To gain the skill of giving bad news of assistant doctors the training needs should be met and they should be supported. More training and experience in areas such as setting the environment, invitation and information are important, especially for the full implementation of the SPIKES protocol.

Keywords

patient-physician communication, breaking bad news, SPIKES protocol

References

• Dean A, Willis S. The use of protocol in breaking bad news: evidence and ethos. Int J Palliat Nurs. 2016;22(6):265-271.
• Atabay G. Kötü haber verme. Çınar Tanrıverdi E, editör. Tıp Eğitiminde İletişim Becerileri. 1. Baskı. Ankara: Türkiye Klinikleri; 2021. p.40-44. (in Turkish)
• Fields SA, Johnson WM. Physician-patient communication: breaking bad news. W V Med J. 2012;108(2):32-35.
• Tanrıverdi EC. Tıpta Kötü Haber Verme. In Aile Hekimliğinde Güncel Yaklaşımlar. Ed. Akpınar E. Bölüm 9. Akademisyen Kitabevi. Ankara, 2019. (in Turkish)
• Kaplan M. SPIKES: a framework for breaking bad news to patients with cancer. Clin J Oncol Nurs. 2010;14(4):514-516.
• Paul C, Clinton-McHarg T, Sanson-Fisher R, Douglas H, Webb G. Are we there yet? The state of the evidence base for guidelines on breaking bad news to cancer patients. European Journal of Cancer. 2009;45(17):2960-2966.
• Baile WF, Buckman R, Lenzi R, Glober G, Beale E, Kudelka AP. SPIKES—a six-step protocol for delivering bad news: application to the patient with cancer. The oncologist. 2000;5(4):302-11.
• Anuk D, Alçalar N, Sağlam EK, Bahadır G. Breaking bad news to cancer patients and their families: Attitudes toward death among Turkish physicians and their communication styles. J Psychosoc Oncol. 2022;40(1):115-130.
• Dias L, Chabner B, Lynch T, Penson R. Breaking bad news: a patient’s perspective. The Oncologist. 2003;8(6):587-596.
• Eng TC, Yaakup H, Shah A et al. Preferences of Malaysian Cancer Patients in Communication of Bad News. Asian Pac J Cancer P, 2012;13:2751-2759.
• Morton J, Blok G, Reid C, Van Dalen J, Morley M. The European Donor Hospital Education Programme (EDHEP): enhancing communication skills with bereaved relatives. Anaesthesia and intensive care. 2000;28(2):184-190.
• Konstantis A, Exiara T. Breaking bad news in cancer patients. Indian J Palliat Care. 2015;21(1):35.
• Baile W, Lenzi R, Kudelka A, et al. Improving physician—patient communication in cancer care: Outcome of a workshop for oncologists. J Cancer Educ. 1997;12(3):166-173.
• Baile W, Kudelka A, Beale E, et al. Communication skills training in oncology: description and preliminary outcomes of workshops on breaking bad news and managing patient reactions to illness. Cancer. 1999;86(5):887-97.
• Park I, Gupta A, Mandani K, Haubner L, Peckler B. Breaking bad news education for emergency medicine residents: A novel training module using simulation with the SPIKES protocol. J Emerg Trauma Shock. 2010;3(4):385.
• Seifart C, Hofmann M, Bär T, Riera Knorrenschild J, Seifart U, Rief W. Breaking bad news–what patients want and what they get: evaluating the SPIKES protocol in Germany. Ann Oncol. 2014;25(3):707-711.
• Ferreira da Silveira F, Botelho C, Valadão C. Breaking bad news: doctors’ skills in communicating with patients. Sao Paulo Med J. 2017;135(4):323-331.
• Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer. Oncologist. 2000;5(4):302-311.
• Fujimori M, Uchitomi Y. Preferences of cancer patients regarding communication of bad news: a systematic literature review. Jpn J Clin Oncol. 2009;39(4):201-216.
• Goldstein D, Thewes B, Butow P. Communicating in a multicultural society II: Greek community attitudes towards cancer in Australia. Intern Med J. 2002;32(7):289-296.
• Berkey FJ, Wiedemer JP, Vithalani ND. Delivering Bad or Life-Altering News. Am Fam Physician. 2018;98(2):99-104.
• Quirt C, Mackillop W, Ginsburg A, Sheldon L, Brundage M, Dixon P, et al. Do doctors know when their patients don't?: A survey of doctor–patient communication in lung cancer. Lung Cancer. 1997;18(1):1-20.
• Moawed S, Youssef I, Elgammal H. Family physicians ability versus other specialty physicians in breaking bad news skills to patient in Suez Canal University Hospital and family practice centers. Asian Stud Med J. 2010;3:2.
• Brown V, Parker P, Furber L, Thomas A. Patient preferences for the delivery of bad news–the experience of a UK Cancer Centre. Eur J Cancer Care. 2011;20(1):56-61.
• Fesci H, Ünal S. Kanserli Hastaların Kötü Haber Almaya İlişkin Görüşleri. TAF Preventive Medicine Bulletin. 2011;10(3).