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Doctors could do a better job of breaking bad news: study
Less than half of German people who are told they have cancer through a set and accepted protocol for breaking bad news are satisfied with the conversation, according to a new study.
Researchers found that may be due to gaps in what patients considered important during that process and what they report actually happened when they got the news.
The study’s lead author told Reuters Health that traditionally doctors thought they were aware of their patients’ preferences and breaking bad news hadn’t been a focus during their training.
“The idea was somehow that physicians will ‘naturally’ have the ability to communicate,” Dr Carola Seifart wrote in an e-mail.
She is from Philipps-University of Marburg in Marburg, Germany. Doctors of all kinds break bad news to their patients, but it’s especially common among oncologists, who diagnose and treat cancer, Seifart and her colleagues write in Annals of Oncology.
For example, the diagnosis of a new cancer or a negative development with an existing cancer can significantly change a person’s view of the future.
In many countries, the so-called Spikes protocol is widely accepted as the standard for breaking bad news.
The protocol is based on six steps that involve finding an appropriate setting, determining what the patient already knows or suspects, understanding what the patient wants to know, knowing how to deliver information the patient understands, being sympathetic and summarising the information at the end of the meeting.
While Spikes has been tested in the US, the researchers write that it has not been tested in Germany and there is little information on how bad news is broken there. They surveyed 350 people who were patients at two medical centres in Germany and had cancer.
The surveys focused on how patients felt the news of their cancer was first broken to them based on the Spikes protocol and which parts of the protocol were most important to them, out of 37 items.
Overall, only about 46 per cent of the participants were completely satisfied with the way the bad news was broken to them. Of the ten parts of Spikes that the patients rated most important, five addressed how doctors provide information or knowledge, three pertained to how doctors conclude the meeting and two were about the setting where the news is delivered.
The researchers compared those preferences to what the participants actually experienced when they received bad news. The greatest difference was between the information participants wanted on their prognosis and what the doctors actually told them.
Based on their findings, the researchers suggest doctors ask about what information patients want and focus on the disease’s prognosis and how it will impact daily life. Doctors should also routinely ask whether patients understand the information and offer them the opportunity to ask questions.
The researchers also suggest that the process of breaking bad news be split over two visits, because many of the participants felt unable to make decisions during the first visit.
Seifart cautioned that the new findings can’t be generalised to all countries.
Dr Walter Baile from The University of Texas MD Anderson Cancer Center in Houston—an expert on the Spikes protocol—also cautioned that the study’s findings are limited, because what the participants reported happening during their visit may be different from what actually happened. (Reuters)
ABOUT SPIKES protocol
Step 1: S—SETTING UP the interview
Step 2: P—Assessing the patient's PERCEPTION
Step 3: I—Obtaining the patient's INVITATION
Step 4: K—Giving KNOWLEDGE and information to the patient
Step 5: E—Addressing the patient's EMOTIONS with empathic responses
Step 6: S—STRATEGY and SUMMARY