A CROSS-SECTIONAL STUDY ON PERSPECTIVES OF PROTOCOL BASED BREAKING BAD NEWS AMONG MEDICAL PATIENTS AND PHYSICIANS AT ST. PAUL’S HOSPITAL MILLENNIUM MEDICAL COLLEGE

Abstract

Abstract Background: Discussing potential bad outcomes is a common communication task in clinical care and patient satisfaction with care and compliance with treatment is dependent upon it. Awareness of physicians on ways how to communicate bad news is considered low, which may occur due to lack of proper training. SPIKES protocol is the most popular and practiced strategy used by physicians but its practice and patients’ perception is not known. Methods: A hospital based descriptive cross-sectional study was conducted at SPHMMC from May 1 to June 30 by using a structured interview administered to patients and physicians. 360 patients and 111 physicians were included, assessment of SPIKES protocol implementation, patient satisfaction, patient preference, physician awareness, and attitude was done. Results: Performance of SPIKES protocol was higher for Setting (74.5%), Perception (51.1%) and Invitation (56.3%) and low for 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% were entirely satisfied with the knowledge they attained. Satisfaction showed significant association with physician asking how much information they would like to be given (P=0.025). Comparison of patient desire and actual report of performance showed significant variation. 82.1% of the physicians were not aware of the protocol and 83.8% have not had any training. Knowledge was the easiest and setting the most difficult for physicians. Physicians face adverse effects with half feeling depressed after disclosure. Conclusions: Patient satisfaction with communication process and knowledge is poor and so is performance of SPIKES protocol components. Satisfaction is related to being asked how much patients want to know. Patient’s desires on how to be told their news is very different from how it is actually done. Breaking bad news increases feeling of being depressed in physicians. Awareness and training on the protocol is very low and medical schools should incorporate it into their studies and implement proper follow-up.