Home' Trinidad and Tobago Guardian : March 4th 2014 Contents A22
body & soul
Guardian www.guardian.co.tt Tuesday, March 4, 2014
YOUR DAILY HEALTH
News and advice
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 con-
versation, 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 nat-
urally 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 Oncol-
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
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 Ger-
many 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 deliv-
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)
Doctors could do a
better job of breaking
bad news: study
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
The study's lead author
said that traditionally
doctors thought they
were aware of their
and breaking bad news
hadn't been a focus
during their training.
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