Breaking bad news in assisted reproductive technology : a proposal for guidelines

Background: The issue of breaking bad news in assisted reproductive technology (ART) has been only partially explored by literature, and although some recommendations are available, specific guidelines are lacking. The present study aimed to explore the applicability of the oncologic SPIKES Protocol to the ART context. Methods: Thirteen ART clinicians (7 gynecologists; 4 psychologists; 1 biologist; 1 obstetrician) completed the Critical Incidents Report (CIR) to describe the experience of delivering bad news in ART. The CIRs were first discussed with clinicians, then a focus group was created composed of 13 clinicians, one health communication expert and a patient to discuss the applicability of the six-step (SPIKES) Buckman Protocol to ART. The discussion was audiotaped, transcribed and analyzed with content analysis. Results: The SPIKES Protocol seems to fit ART consultations and participants found it practical and easy to understand. Some specificities were found for the ART context: the reiteration of bad news, the "patient" as a couple and the fact that ability to conceive is closely related to self-esteem, as well as to social and family identity. During the discussion of the SPIKES Protocol, participants highlighted the importance of: 1) providing a caring setting, by adding a reflection on the value of communication by phone; 2) exploring patients perceptions but also misinformation; 3) exploring patients desires and expectations, while balancing the need to be honest and clear; 4) applying Buckmans suggestions for delivering information, and integrating clinical aspects with psychosocial ones; 5) managing and legitimizing patients emotions, in particular anger; 6) having a strategy for follow-up and supporting couples to make meaning of the ART experience. Conclusion: The proposal of a shared protocol for giving bad news in ART could be the starting point for training and experimental studies.