Mai-King Chan, MD.  Associate Clinical Professor, Department of Pediatrics, Division of Hospital Medicine, David Geffen School of Medicine at UCLA

Elizabeth Volpicelli, MD.  Pediatric Fellow in Developmental and Behavioral Pediatrics, David Geffen School of Medicine at UCLA

Samantha Zimmer, Medical Student at UC Riverside

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.

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.

Results

A cohort of pediatric interns (N = 29) completed the SPIKES Protocol training in June 2023. Twenty-seven participants completed the pre- and post-survey. A second cohort of pediatric interns (N=29) completed the SPIKES Protocol training in June 2024. Twenty-six participants completed the pre- and post-survey. 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). 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). Twelve participants from the 2023 cohort completed a follow-up survey nine months after the SPIKES training demonstrating continued increased confidence levels in their ability to deliver bad news.

Conclusion

This study demonstrates that formal training on the SPIKES Protocol can improve the confidence of first-year pediatric residents in delivering bad news.