Resident Physician UCLA Mattel Childrens Hospital Pacific Palisades, California, United States
Background: Physicians are routinely tasked with the challenging responsibility of breaking bad news to patients and their families. The SPIKES Protocol was developed by Dr. Robert Buckman and Dr. Walter Baile after recognizing the need for a structured approach to guide healthcare professionals through delivering distressing medical information. Previous studies have shown that the SPIKES Protocol can improve confidence among healthcare providers. However, there is limited research on its effectiveness among pediatric residents. Objective: The purpose of this study is to determine if formal training on the SPIKES Protocol improves the confidence of first-year pediatric residents in delivering bad news. Design/Methods: A 2-hour training consisting of an interactive lecture, a pre-recorded standardized patient encounter, and 3 case-based simulated patient experiences was developed to equip pediatric interns with the knowledge and skills needed to effectively and compassionately disclose unfavorable medical information. Pre- and post-surveys using a 5-point Likert scale were administered to assess level of confidence in breaking bad news prior to and after the training. Paired sample t-tests were performed to determine if there was a statistical difference (p < 0.05) between the pre- and post-survey mean confidence scores. Results: A cohort of pediatric interns (N = 29) completed the training in June 2023. Twenty-seven participants completed the pre- and post-surveys. Paired sample t-tests revealed a statistically significant increase in confidence for each step of the SPIKES Protocol: set up a private and quiet environment (p = 0.02), assess patient's/family's perception (p < 0.001), obtain patient's/family's invitation (p < 0.001), use clear, non-medical language (p < 0.001), respond to patient's/family's emotions with empathy (p = 0.04), summarize the diagnosis and treatment plan (p = 0.001), and strategize future plans and next steps (p < 0.001) (See Figure 1). Additionally, 100% of participants reported feeling more confident in their ability to deliver bad news after participating in the training (62.1% strongly agreed and 37.9% somewhat agreed).
Conclusion(s): This study demonstrates that formal training on the SPIKES Protocol can improve the confidence of first-year pediatric residents in delivering bad news. Thus, the training has been integrated into the UCLA Pediatric Residency Program’s Intern Orientation Curriculum. The SPIKES Protocol training will soon be offered to pediatric fellows and attendings at UCLA to ensure better outcomes for both healthcare providers and those they are serving.
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