告知坏消息：一项横断面研究，评估尼日利亚医生对SPIKES协议的依从性及采用的其他方法。

Breaking bad news: a cross-sectional study assessing SPIKES protocol adherence and other methods employed among medical doctors in Nigeria.

作者信息

Ipinnimo Tope Michael, Asake Olumide Temitope, Olowoselu Oluwafemi Oreoluwa, Sanni Taofeek Adedayo, Adekeye Abolaji Paul, Adepoju Rasheed Adeyemi, Akinlua Gbenga Damilola, Ajayi Paul Oladapo, Adeojo Oluwole Michael, Afolayan Christiana Aderonke, Bamidele Tolulope Ayodeji, Faleke Olaoye Michael, Akomolafe Shina Emmanuel, Akingunloye Olabode Nelson, Alo Akinleye Lawrence, Dada Moses Blessing, Abioye Opeyemi Oladipupo, Omotunde Olubunmi Tolu, Erinomo Olagoke Olaseinde, Ojo John Olujide

机构信息

Department of Community Medicine, Federal Teaching Hospital, Ido-Ekiti, Nigeria.

Department of Community Medicine, Afe Babalola University, Ado-Ekiti, Nigeria.

出版信息

BMC Prim Care. 2025 Apr 28;26(1):133. doi: 10.1186/s12875-025-02832-y.

DOI:10.1186/s12875-025-02832-y

PMID:40295981

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12036165/

Abstract

BACKGROUND

The SPIKES (Setting, Perception, Invitation, Knowledge, Empathy, and Strategy) protocol has been widely used in many developed countries for breaking bad news (BBN), however, serious uncertainty remains in its understanding and implementation in many developing nations. This study aims to assess adherence to SPIKES protocol and its associated factors, in addition to exploring alternative techniques used to BBN among medical doctors in Nigeria.

METHODS

A cross-sectional study was conducted in Ekiti State, Nigeria among 245 medical doctors selected through a systematic sampling technique in May, 2024. A semi-structured questionnaire, adapted from a previous study was used to collect information on biodata, practice of SPIKES protocol, and an open-ended question that asked how the respondents break bad news. Frequencies, logistic regression, and content analysis (for the open-ended question) were conducted.

RESULTS

Overall, 178 (72.7%) doctors fully adhered to the SPIKES protocol with Settings (98.4%), Perception (93.9%), Invitation (76.7%), Knowledge (99.2%), Empathy (98.0%) and Strategy (98.4%). Clinical position(p = 0.002) and education or training(p = 0.034) were significant on bivariate. Predictors of full SPIKES adherence were doctors at public tertiary (AOR = 0.132; 95%CI = 0.029-0.600) and public secondary/primary health facilities (AOR = 0.079; 95%CI = 0.012-0.502) than those in private health facilities; doctors that are pediatricians (AOR = 0.109; 95%CI = 0.023-0.515) than the general practitioners. Content analysis shows many doctors adopt the full SPIKES protocol, use different aspects of it (SPIKES variants viz the Knowledge and Empathy (KE), Setting and Knowledge (SK), and the Setting, Knowledge, and Empathy (SKE)), some use no specific protocol, adopt the religious/spiritual approach, and other (Blunt, Diplomatic and BATHE) methods/Approaches.

CONCLUSIONS

Achieving consistent BBN practice requires continuous training and more support as shown by variability in adherence influenced by factors such as training and education, healthcare facility, and specialty.

摘要

背景

SPIKES（背景、认知、邀请、信息、共情和策略）协议已在许多发达国家广泛用于传达坏消息（BBN），然而，在许多发展中国家，对其理解和实施仍存在严重的不确定性。本研究旨在评估对SPIKES协议的遵守情况及其相关因素，此外还探索尼日利亚医生用于传达坏消息的其他技术。

方法

2024年5月在尼日利亚埃基蒂州进行了一项横断面研究，通过系统抽样技术选取了245名医生。采用一份改编自先前研究的半结构化问卷收集有关生物数据、SPIKES协议实践的信息，以及一个开放式问题，询问受访者如何传达坏消息。进行了频率分析、逻辑回归和内容分析（针对开放式问题）。

结果

总体而言，178名（72.7%）医生完全遵守SPIKES协议，其中背景（98.4%）、认知（93.9%）、邀请（76.7%）、信息（99.2%）、共情（98.0%）和策略（98.4%）。在双变量分析中，临床职位（p = 0.002）和教育或培训（p = 0.034）具有显著性。完全遵守SPIKES协议的预测因素是公立三级医疗机构（调整后比值比[AOR]=0.132；95%置信区间[CI]=0.029 - 0.600）和公立二级/一级医疗机构（AOR = 其0.079；95%CI = 0.012 - 0.502）的医生比私立医疗机构的医生；儿科医生（AOR = 0.109；95%CI = 0.023 - 0.515）比全科医生。内容分析表明，许多医生采用完整的SPIKES协议，使用其中的不同方面（SPIKES变体，即信息和共情（KE）、背景和信息（SK）以及背景、信息和共情（SKE）），一些医生不使用特定协议，采用宗教/精神方法，以及其他（直接、委婉和BATHE）方法/途径。