Perspectives of Protocol Based Breaking Bad News among Medical Patients and Physicians in a Teaching Hospital, Ethiopia

Abstract

BACKGROUND፡ Discussing potentially bad outcomes is a standard communication task in clinical care. Physicians’ awareness on ways to communicate bad news is considered low. SPIKES protocol is the most popular strategy used by physicians, but its practice and patients' perception are not known. This study attempted to fill the knowledge gap on protocol implementation, patient preference and physician effects.METHODS: Hospital-based descriptive cross-sectional study was conducted at SPHMMC from May 1 to June 30 using structured interviews administered to patients and physicians. Three hundred and sixty patients and 111 physicians were included. Assessment of SPIKES performance, patient satisfaction, patient preference, and physician awareness, attitude and effects were studied.RESULTS: Performance of SPIKES protocol was setting (74.5%), perception (51.1%), invitation (56.3%), knowledge (15.9%), emotion (22.3%) and summary (10.1%). Only 30.6% of the patients were entirely satisfied with the interaction, and 19.2% with knowledge attained. Patient satisfaction was associated with physician asking how much information they like (P=0.025). Patient desire and report showed variation. Eighty-two percent of the physicians were not aware of the protocol, and 83.8% had no training. Half of the physicians feel depressed after disclosure.CONCLUSIONS: Patient satisfaction with communication process and knowledge is poor, as is performance of SPIKES components. Satisfaction is related to being asked how much patients want to know. Patients’ desires on how to be told news is different from how it is done. Breaking bad news increases feeling of depression. Awareness and training on the protocol are deficient; medical schools should incorporate it into their studies and implement proper follow-up.

Physicians’ Skills in Breaking Bad News to Patients With Cancer Using SPIKES Protocol

“…Alnefaie et al from Saudi Arabia reported that 38.3% of surgeons in academic hospitals were aware of the SPIKES protocol. Only 20% had received specific training courses, while most of them agreed on the necessity of improving their communication skills Fisseha et al from Ethiopia discussed that the SPIKES protocol was poorly implemented, and only 30.6% of patients were delighted with the physicians' communication [25]. As mentioned above, the results of studies in different areas are contradictory.…”

Communication of bad news from the perspective of oncologists and palliative care physicians

“…Among the existing communication protocols for conveying bad news, SPIKES is one of the most popular worldwide 11 . In the literature, the greater prominence of SPIKES is justified by its flexibility 12 .…”

“…Regarding In fact, studies carried out in different countries disclose a lack of training during academic formation, which explains many of the problems reported by health professionals 9,11,15 .…”

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“…Dentre os protocolos de comunicação de más notícias existentes, o SPIKES é um dos mais populares em todo o mundo 11 .…”

“…De fato, estudos realizados em diferentes países revelam uma insuficiência de treinamentos durante a formação acadêmica, o que explica muitos dos problemas relatados pelos profissionais de saúde 9,11,15 . No Brasil, uma pesquisa recente, com 162 escolas médicas, constatou o ensino da comunicação de más notícias em apenas 41 delas 16 .…”