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Breaking bad news: Awareness and practice among Sudanese doctors

1 Faculty of Medicine, University of Gezira, Sudan
2 Armed Forces Centre for Psychiatric Care, Taif, Saudi Arabia
3 College of Medicine and Medical Education Center, University of Sharjah, Sharjah, United Arab Emirates
4 Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, UK

Background: Breaking bad news is an important task for doctors in different specialties. The aim of the study was to assess adherence of Sudanese doctors to the SPIKES protocol in breaking bad news. Methods: A descriptive cross-sectional study recruited 192 doctors, at Wad Medani teaching hospital, Sudan. A questionnaire-based on SPIKES protocol was distributed among 10 departments in our hospital. Data were analyzed using SPSS and Microsoft excel. Results: There were (n = 101, 52.6%) females and (n = 91, 47.4%) males among the participants. 95.3% have been involved in breaking bad news, but only 56.3 received education and training about this issue. 43% admitted bad experience in breaking bad news, while 65.6% mentioned that bad news should be delivered directly to patients. The majority (>90%) agreed training is needed in the area of breaking bad news . Usual adherence to the SPIKES protocol was reported in a range of 35–79%, sometimes adherence was reported in a range of 20–44% while never adherence was reported in a range of zero–13.5%. Consultants, registrars, obstetrician and gynecologists and surgeons achieved high scores in breaking bad news. Training is an important factor in achieving high score in SPIKES protocol. The unadjusted effect of background factors on SPIKES score, showed that only training has significant impact on protocol adherence (P = 0.034, unadjusted; and P = 0.038 adjusted). Conclusion: Large number of Sudanese doctors will try to adhere to SPIKES protocol. Training is an important factor in the success of breaking bad news.
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1. Buckman R (1992) How to break bad news: a guide for health care professionals. JHU Press.

2. Azzopardi J, Gauci D, Parker PA, et al. (2017) Breaking bad news in cancer: an assessment of Maltese patients' preferences. Malta Med Sch Gaz 1: 36–45.

3. Lamprell K, Braithwaite J (2018) When patients tell their own stories: a meta-narrative study of web-based personalized texts of 214 melanoma patients' journeys in four countries. Qual Health Res 28: 1564–1583.    

4. Warmenhoven F, Lucassen P, Vermandere M, et al. (2016) 'Life is still worth living': a pilot exploration of self-reported resources of palliative care patients. BMC Fam Pract 17: 52.    

5. Weilenmann S, Schnyder U, Parkinson B, et al. (2018) Emotion transfer, emotion regulation, and empathy-related processes in physician-patient interactions and their association with physician well-being: a theoretical model. Front Psychiatry 9: 389.

6. Monden KR, Gentry L, Cox TR (2016) Delivering bad news to patients. In: Baylor University Medical Center Proceedings. Taylor & Francis, 29: 101–102.

7. Vijayasarathi A, Kharkar R, Salamon N (2019) Strategies for patient-Centered communication in the digital age. Curr Probl Diagn Radiol 48: 210–215.    

8. Derry HM, Epstein AS, Lichtenthal WG, et al. (2019) Emotions in the room: common emotional reactions to discussions of poor prognosis and tools to address them. Expert Rev Anticancer Ther 19: 689–696.    

9. Matthews T, Baken D, Ross K, et al. (2019) The experiences of patients and their family members when receiving bad news about cancer: A qualitative meta‐synthesis. Psycho‐Oncology 28: 2286–2294.    

10. Seifart C, Hofmann M, Bär T, et al. (2014) Breaking bad news–what patients want and what they get: evaluating the SPIKES protocol in Germany. Ann Oncol 25: 707–711.    

11. Johnson J, Panagioti M (2018) Interventions to improve the breaking of bad or difficult news by physicians, medical students, and interns/residents: a systematic review and meta-analysis. Acad Med 93: 1400–1412.    

12. Kaplan M (2010) SPIKES: a framework for breaking bad news to patients with cancer. Clin J Oncol Nurs 14: 514.    

13. Fallowfield L, Jenkins V (2004) Communicating sad, bad, and difficult news in medicine. Lancet 363: 312–319.    

14. Teike FL, Cantin B (2011) Breaking bad news:"EPICES", a French style as a learning method. Rev Med Suisse 7: 85–87.

15. Boissy A, Windover AK, Bokar D, et al. (2016) Communication skills training for physicians improves patient satisfaction. J Gen Intern Med 31: 755–761.    

16. von Blanckenburg P, Hofmann M, Rief W, et al. (2020) Assessing Patients' Preferences for Breaking Bad News according to the SPIKES-Protocol: The MABBAN Scale. Patient Educ Couns 103: 1623–1629.    

17. Dean A, Willis S (2016) The use of protocol in breaking bad news: evidence and ethos. Int J Palliat Nurs 22: 265–271.    

18. Karnieli-Miller O, Neufeld-Kroszynski G (2018) The potential of argumentation theory in enhancing patient-centered care in breaking bad news encounters. J Argumentation Context 7: 120–137.    

19. Nezu AM, Nezu CM, Hays AM (2019) Emotion-Centered Problem-Solving Therapy. Handb Cogn Ther 2019: 171.

20. Taha MH (2019) Assessing patient satisfaction with Sudanese doctors. J Adv Med Educ Prof 7: 106–107.

21. Kee JWY, Khoo HS, Lim I, et al. (2018) Communication skills in patient-doctor interactions: learning from patient complaints. Health Prof Educ 4: 97–106.    

22. Lee HR, Yi SY, Lee HR, et al. (2013) Delivering bad news to a patient: a survey of residents and fellows on attitude and awareness. Korean J Med Educ 25: 317–325.    

23. Ferreira da Silveira FJ, Botelho CC, Valadão CC (2017) Breaking bad news: doctors' skills in communicating with patients. Sao Paulo Med J 135: 323–331.    

24. Adebayo PB, Abayomi O, Johnson PO, et al. (2013) Breaking bad news in clinical setting-health professionals' experience and perceived competence in southwestern Nigeria: A cross sectional study. Ann Afr Med 12: 205–211.    

25. Klyce W (2018) On Breaking Bad News. JAMA 320: 135–136.    

26. Fuerst NM, Watson JS, Langelier NA, et al. (2018) Breaking Bad: An Assessment of Ophthalmologists' Interpersonal Skills and Training on Delivering Bad News. J Acad Ophthalmol 10: e83–91.    

27. Brouwers MH, Bor H, Laan R, et al. (2018) Students' experiences with a longitudinal skills training program on breaking bad news: A follow-up study. Patient Educ Couns 101: 1639–1644.    

28. Brouwers M, van Weel C, Laan R, et al. (2019) Training Undergraduates Skills in Breaking Bad News: How Students Value Educators' Feedback. J Cancer Educ 34: 1103–1106.    

29. Al-Mohaimeed AA, Sharaf FK (2013) Breaking bad news issues: a survey among physicians. Oman Med J 28: 20.    

30. Ungar L, Alperin M, Amiel GE, et al. (2002) Breaking bad news: structured training for family medicine residents. Patient Educ Couns 48: 63–68.    

31. Naseem S (2018) "Breaking breast cancer news" with ethnic minority: a UK experience. J Multidiscip Healthc 11: 317–322.    

32. Muneer MS, Elhassan AE, Osman AM, et al. (2018) Breaking bad news from the doctors' perspective in a paternalistic society: the case of Sudan. Trop Doct 48: 340–344.    

33. Elsiddek AM, Eltayeib E, Salahedin M, et al. (2014) Breaking Bad News for Patients with Gastro-Intestinal Malignancy: Experience at Ibn Sina Teaching Hospital. Sudan J Med Sci 9: 1–4.

34. Salem A, Salem AF (2013) Breaking bad news: current prospective and practical guideline for Muslim countries. J Cancer Educ 28: 790–794.    

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