Breaking bad news: doctors’ skills in communicating with patients

ABSTRACT CONTEXT AND OBJECTIVE: Breaking bad news is one of doctors’ duties and it requires them to have some skills, given that this situation is difficult and distressful for patients and their families. Moreover, it is also an uncomfortable condition for doctors. The aim of this study was to evaluate doctors’ capacity to break bad news, ascertain which specialties are best prepared for doing this and assess the importance of including this topic within undergraduate courses. DESIGN AND SETTING: Observational cross-sectional quantitative study conducted at a university hospital in Belo Horizonte (MG), Brazil. METHODS: This study used a questionnaire based on the SPIKES protocol, which was answered by 121 doctors at this university hospital. This questionnaire investigated their attitudes, posture, behavior and fears relating to breaking bad news. RESULTS: The majority of the doctors did not have problems regarding the concept of bad news. Nevertheless, their abilities diverged depending on the stage of the protocol and on their specialty and length of time since graduation. Generally, doctors who had graduated more than ten years before this survey felt more comfortable and confident, and thus transmitted the bad news in a better conducted manner. CONCLUSION: Much needs to be improved regarding this technique. Therefore, inclusion of this topic in undergraduate courses is necessary and proposals should be put forward and verified.摘要背景与研究目标 告知坏消息是医师的职责之一，该场景对患者及其家属而言既艰难又令人痛苦，而对医师本身而言同样是一种令人不适的处境。本研究旨在评估医师告知坏消息的能力，明确哪些专科医师在该领域的准备最为充分，并探讨将该主题纳入本科医学课程的必要性。 研究设计与实施场景 本研究为观察性横断面定量研究，实施地点位于巴西贝洛奥里藏特市（MG州）的一所大学附属医院。 研究方法 本研究采用基于SPIKES沟通协议（SPIKES protocol）的调查问卷，共有该大学附属医院的121名医师参与作答。该问卷调研了医师在告知坏消息过程中的态度、姿态、行为表现及内心顾虑。 研究结果 多数医师对告知坏消息的相关概念并无认知障碍，但医师的实际能力会因协议流程阶段、所在专科及毕业年限的不同而存在差异。总体而言，在本次调研前毕业超过十年的医师，在告知坏消息时会更为从容自信，沟通流程也更为规范得当。 研究结论 目前医师告知坏消息的相关技能仍有诸多待完善之处。因此，将该主题纳入本科医学课程实属必要，相关优化方案有待提出并加以验证。