Practices, Attitudes of Doctors and Patient’s Perspectives Regarding Breaking Bad News at a Tertiary Health Centre

Abstract

Introduction: Breaking bad news using SPIKES protocol will help effective bad news delivery to the patients. Assessing doctor’s practices and attitudes in bad news delivery and exploring patient’s perspectives on how bad news was delivered to them could give information about doctors’ communication with patients. This study aimed to assess doctors’ practices and attitudes of breaking of bad news and explore patients’ perspectives.
Methods: The authors did questionnaire based qualitative and quantitative cross sectional study at a tertiary health centre in Nepal. They asked 75 doctors from various departments regarding their practices of breaking bad news as per SPIKES protocol. They inquired the same number of patients/relatives about how the bad news was broken to them. Practice scores among doctors were analyzed. The response of patients were compared with the doctors’. 
Results: MD residents and doctors from Pediatric ICU/Neonatal ICU had better practice scores than Medical officers and doctors from Emergency department respectively. Consultants felt more confident in breaking bad news. Eighty four percent of the doctors wanted to deliver the bad news to the family members first than the patient.  Most of the doctors believed they broke bad news as per the SPIKES protocol. However, as per patient’s perspectives they were not delivered the news as per the protocol.
Conclusion: Most of the doctors agreed to practice breaking bad news as per SPIKES protocol and felt confident in doing so. There was a discrepancy regarding patient’s perspectives and doctor’s practice in how delivery of bad news was done.