Citation: Haematologica. 2015, 100, 574-575
Author: Dixon L.
Abstract: Background: Sharing potentially devastating news with a patient is often considered the
most difficult task of a healthcare professional. The quality of the delivery of the bad
news can have a direct impact on patients' emotions and adjustment to the condition;
therefore doctors have a great responsibility. Aims: The main aim of this study was to
learn the theory behind breaking bad news and discover patients' perceptions of receiving
bad news in the haematology setting; including what they thought was done well and
areas that could be improved. The study was designed following the SPIKES protocol
because it comprises the basic principles and provides a structure. There is an ever
increasing amount of literature available surrounding this topic. Yet, there is a noticeable
lack of research concentrating on the experience from the patient's view. Methods: A
questionnaire was written based on the steps of the SPIKES model. The questions were
divided into sections. The first section, titled 'patient demographics', aimed to elicit
personal information without comprising anonymity. The next six sections represented the
six steps of the SPIKES model. There were a mixture of qualitative responses and
multiple choice answers; however the participants were always able to give qualitative
responses if they felt there were no multiple choice answers that represented their views.
The participants were asked the questions by interviewers, who documented their
answers. The interviewers were also available to explain the questions to the participants.
The questionnaire was attempted by 20 participants who were in/out patients at Arrowe
Park Hospital. The inclusion criteria for participation comprised a diagnosis of a
haematological malignant disease and treatment for the disease at this hospital.
Additionally, it was essential the patients gave voluntary and informed verbal consent.
Results: Due to help from the interviewers, all of the 20 questionnaires attempted were
completed and used in this study. The participants rated their experience: 55% said
'excellent'; 25% reported 'good'; 5% said 'satisfactory' and 15% stated 'poor'. 'Poor' was
rated more commonly by women and participants aged 45-64. Those who received their
diagnosis within the past few years tended to have a better consultation. The main
differences between the 'excellent' and 'poor' consultations include the doctor's sensitivity
and the patients having their understanding checked. Problem areas include only 35% of
patients were asked their existing knowledge and 85% of consultations failed to discuss
the impact of the diagnosis on daily life. Summary and Conclusions: Overall, most
patients were happy with their consultation. The areas patients particularly praised were
the set-up of the consultation and how sensitively the news was delivered. The knowledge
section was done well generally, however it showed the greatest difference between 'poor'
and 'excellent' consultations; therefore should be improved to standardise the experience.
Other areas patients felt needed improvement include the doctor determining the patient's
existing knowledge and what they would like to know. With a poorer prognosis, doctors
should work on reassurance and conveying hope. Most consultations could be improved
by the doctor exploring the effect of the diagnosis on other areas of the patient's life. This
study was limited by a small sample size and potential recall bias.
