Breaking Bad News to Patients: Physicians’ awareness and Practice

Abstract

Background: Breaking bad news (BBN) is a routine yet distressing task for physicians and patients. Patients suffer considerable discomfort when bad news such as disease recurrence, spread or treatment failure is disclosed to them. Their physicians, therefore, should acquire effective communication skills to help them overcome these feelings. Objectives: To assess the physicians' awareness and practice of breaking bad news to patients. Methods: A crosssectional study was carried out in a rural Family Health Center (FHC), Menoufia, Egypt. A semi-structured questionnaire based on the 6-step SPIKES protocol for BBN was administered to 170 physicians working and training in the FHC to assess their awareness of the process. The practice of these physicians was assessed against a checklist. Results: About 68% of the physicians had good awareness of the components of the 6-step SPIKES protocol, while 58% implemented the protocol at a fair level. There was a statistically significant difference among physicians' results based on specialties where family physicians and general practitioners had higher awareness and practice scores. As regards their qualifications, physicians with Ph.D. degrees or fellowships had statistically significant better awareness and practice scores. The physicians who received training on breaking bad news had higher awareness and practice scores. There was a statistically significant positive correlation between participants' years of experience and their awareness and practice. Conclusion: Physicians' BBN awareness is good; however, their technique of practicing is fair. It is a neglected issue in physicians' education and training, particularly in the case of novice physicians.

Assessing Physicians’ Knowledge, Attitude, and Practice towards Breaking Bad News: A Multicenter Study in Egypt

“…The guidelines also are based on psychological aspects of which psychiatrists are most aware. This differs from the findings of other studies that found that family physicians and GPs have the highest scores [20,22] .…”

“…In the current study, the vast majority (91%) of physicians have a good agreement level and 8.6% had a partial agreement level with the principles of SPIKES protocol. This is similar to previous study done in Egypt [20] that found that more than two-thirds of the physicians had a good level of agreement and a qualitative study in Greece where all physicians agreed on the necessity to have principles for BBN similar to the SPIKES principles. In some studies, although physicians had appropriate awareness of the importance of BBN protocols, their practice was still unsatisfactory due to the absence of a consistent communication process and standardized procedures for BBN [21] .…”

“…The younger and older age groups physicians (≤ 30 and > 40) have got the highest BBNAS scores. This agrees with research by Farber and colleagues [22] that found physicians over the age of 50 years well performing emotional items than younger, which differs with studies of Menoufia, Egypt [20] , Sudan [16] , and Saudi Arabia [17] . But there was no significant correlation between age and empathy similar to a study carried out at Tabriz University, Iran [24] .…”

“…In some studies, although physicians had appropriate awareness of the importance of BBN protocols, their practice was still unsatisfactory due to the absence of a consistent communication process and standardized procedures for BBN [21] . In an Egyptian study conducted in a family health center in Menoufia Governorate, only 68% of physicians had good knowledge about the SPIKES protocol even though 100% of them received previous training on it [20] , which indicates that training only is not enough to maintain knowledge but rather the continuous practical application.…”

“…This explanation was also provided by Rasmus and colleagues (23) when they investigated the gender variations in the BBN approach at the Emergency Room. But in studies conducted in Egypt and Sudan, gender was found to be not associated with agreement or adherence to the SPIKES' protocol [16,20] .…”