The SPIKES protocol is not applied in the process of breaking bad news to patients with Schizophrenia

Doron Amsalem, Ilanit Hasson-Ohayon, David Roe, Doron Gothelf

Research output: Contribution to journalArticlepeer-review


Background: There are no clear guidelines for breaking bad news in psychiatry. This study aims to investigate whether the SPIKES protocol (Setting, Perception, Invitation, Knowledge, Empathy and Summary), which is used in general medicine, is applied in psychiatry, and to evaluate the respondents’ subjective opinions about the encounter. Methods: Semi-structured interviews were conducted according to the SPIKES protocol, and a questionnaire designed for the purposes of this study (delivering difficult news satisfaction and acceptance questionnaire, DDNSAQ) was filled in by the study participants. Results: Sixteen people who recently received a schizophrenia spectrum diagnosis and 15 of their firstdegree relatives completed the SPIKES interview and the DDNSAQ. The SPIKES protocol for delivering bad news was generally not followed. The way relatives learned about the diagnosis (i.e., in a planned vs an unplanned manner) correlated positively with several DDNSAQ items, including receiving the expected information, agreement with the diagnosis, quality of the communication with the clinician (p<0.001 for each), and general satisfaction (p=0.04). Conclusions: The SPIKES protocol of delivering bad news in medicine was not applied in this sample with most psychiatric patients and their relatives. A SPIKES protocol adapted to delivering difficult news in psychiatry is needed in order to improve the way of communicating the diagnosis to patients and relatives.

Original languageEnglish
Pages (from-to)28-32
Number of pages5
JournalIsrael Journal of Psychiatry and Related Sciences
Issue number2
StatePublished - 2019

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ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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