28 February 2021

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Breaking bad news in dentistry

Authors:Silvia Poli, Daniela Sorrentino, Giovanni Lodi, Elena Vegni

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Communicating bad news is a difficult and stressful task for all healthcare professionals, including dentists. Effective communication of bad news is essential as it promotes better acceptance of the disease, improved adaptation and decreased stress in the patient. Learning how to give bad news effectively is, therefore, an important part of clinical work. However, specific training on breaking bad news is not common. A versatile, validated and learnable strategy is the S-P-I-K-E-S protocol developed by Buckman. The aim of this article is to illustrate the application of the SPIKES protocol in the dental field. Firstly, it is necessary to underline that breaking bad news is a complex task and the clinician may encounter many difficulties including the fear of causing pain, an erroneous perception of failure, the unpredictability of the patient's reactions, the inability to provide a treatment plan. Such difficulties can lead to delays in communication or even to the communication of partial and misleading information. Another important aspect is the definition of bad news, which is not objectively identifiable but depends on the patient's expectations. Therefore, a wide range of clinical situations can be considered as bad news and it must be taken into account that patients and dentists view on what can be considered as negative may differ significantly.

Materials and methods.
The SPIKES protocol includes 6 steps for the communication of bad news: Setting (prepare of the context in which the bad news will be given); Perception (assess the patient's degree of awareness of the situation); Invitation (invite the patient to explain what he would like to know about the diagnosis and prognosis); Knowledge (provide useful information taking into account the patient's needs); Emotion and Empathy (facilitate the expression of emotions and respond to them empathetically); Summarize and strategize (define an action strategy with the patient, summarizing the highlights and checking understanding).

Results.
The SPIKES protocol provides a set of essential and flexible guidelines for breaking bad news appropriate to the dental context. These guidelines allow the dentist to respond to the patient's needs in a personalized and person-centred way.

Conclusions.
Knowledge of the SPIKES protocol is fundamental in dental clinical practice. However, in addition to the knowledge of the protocol, continuous training based on active and experiential methods is needed to internalize the most effective way to communicate bad news. Furthermore, research in the dental field is needed to understand the experience of the dentist and to investigate specific aspects of communicating bad news in this clinical setting.