Deliver bad news – a cross-sectional study of the communication strategies used by physicians at the Maputo Central Hospital, Mozambique

Abstract

Background: Physician communication with the patient and the family is an indispensable tool both on the disease diagnosis and prognosis, and also through all the follow-up, improving patients’ quality of life. This is even more important in case of terminal disease and the patient has palliative needs. Thus, the aim of this study was to identify which bad news communication strategies doctors use in services that provide palliative care. Methods: A cross-sectional, quantitative, and analytical study was developed with the physicians that worked at the departments that provide palliative care at the Maputo Central Hospital, Mozambique. A total of 121 doctors participated in this study. An existing questionnaire with 17 questions, already translated to Portuguese, was used, based on the Setting-Perception-Invitation-Knowledge-Emotions-Strategy(SPIKES) protocol, and complemented with socio-demographic questions. A question about the participants’ opinion regarding the inclusion of how to communicate bad news in hospital training was also added. Results: Of the 121 doctors, 62 (51.2%) were male and 110 (90.9%) were general practitioners. The participants had a median age of 36 years old and medians of 8 years of clinical practice and of 3 years of work in the current service. The majority of the participants considered that they have an acceptable or good level of bad news communication skills and believed that they do it in a clear and empathic way, paying attention to the patients' requests and doubts; however, most were not aware of the existing tools to assist them in this task and pointed that this topic should be addressed in the undergraduate medical course and in hospital training. Conclusions: This study adds new information about the bad news communication strategies used by doctors in the context of palliative care at the Maputo Central Hospital. Since palliative care are still being implemented in Mozambique, it is important to use protocols suitable to the reality of the country to allow the improvement in the conduct and attitudes of doctors towards patients and family members.