Sharing Unpleasant Health Updates with Patients: A baseline study exploring physician attitudes, practices, and adherence to the SPIKES protocol at a tertiary hospital in Muscat, Oman

Abstract

Objectives: This study aimed to investigate knowledge, attitudes, and experiences in sharing unpleasant health information and adherence to the SPIKES protocol among physicians at a tertiary hospital in Muscat, Oman. Methods: This cross-sectional study was conducted at the Sultan Qaboos University Hospital (SQUH) from August to October 2022. An electronic, self-administered questionnaire was used to gather data from 400 physicians across various SQUH departments. Results: A total of 89 physicians completed the questionnaire (response rate: 22.3%). Most (96.6%) recognised the need for additional training in the delivery of unpleasant health updates, with 78.7% expressing their willingness to undertake such training. However, 32.6% reported negative experiences due to improper delivery of bad news, with an equal proportion admitting to disclosing unpleasant updates to the patient’s family without their consent. The majority (86.5%) demonstrated a high level of overall adherence to the SPIKES protocol, with 59.6–85.4%, 12.4–34.8%, and 1.1–11.2% of physicians reported usually, sometimes, and never following specific steps of the protocol, respectively. Marital status (P = 0.015) and qualifications (P = 0.032) were the only variables to correlate with adherence level, with married physicians and those with board or fellowship certificates reporting significantly better adherence compared to their counterparts. Conclusion: Physicians in Oman encountered challenges in delivering unpleasant health updates, underscoring the interplay of cultural influences, training, and adherence to protocols. To address these challenges, targeted and frequent training programs are recommended, starting from undergraduate medical education and extending to continuous opportunities for physicians at various career levels.

Keywords: Physician-Patient Relations; Truth Disclosure; Clinical Protocols; Communication; Empathy; Oman.