# Healthcare Professionals Describe Difficulties Encountered When Breaking Bad News to Oncology Patients: An Italian Observational Study

## TL;DR

Italian healthcare professionals face significant stress and lack proper training when delivering bad news to oncology patients, highlighting the need for better communication tools and training.

## Contribution

The study identifies specific communication challenges and stressors among healthcare professionals in oncology, emphasizing the need for targeted training and adoption of evidence-based methods like SPIKES.

## Key findings

- Most healthcare professionals learned difficult conversations from mentors or courses, but many still struggle with delivering bad news.
- A significant proportion of participants were unfamiliar with the SPIKES method, and stress levels increased when using evidence-based tools.
- Moderate stress was frequently experienced during specific communication tasks, such as managing patient reactions and post-communication consequences.

## Abstract

Background: Many nurses and physicians report difficulties with breaking bad news to their patients due to the lack of adequate skills and training. This study aimed to explore the communication skills, knowledge, and self-perceived difficulties of healthcare professionals working in oncology and hematology settings in Italy, in relation to their self-perceived stress levels when communicating bad news. Methods: An “ad hoc” questionnaire and the Perceived Stress Scale were administered online to both physicians and nurses registered by two important professional associations between October 2023 and September 2024. Results: A total of 221 Italian physicians and nurses were enrolled in the study. Most participants reported learning how to conduct difficult conversations from a mentor (61.1%) or through specific courses (56.6%). However, many of the recruited subjects declared having difficulty in giving bad news to the patient and family members (84.2%), and many of them did not know the SPIKES method (63.8%). A moderate level of stress was perceived by the great majority of participants, and the stress level was significantly increased in healthcare professionals who had difficulties in using evidence-based tools (e.g., SPIKES) for bad news communication. Moderate stress was “often” experienced by participants when presenting themselves during the first approach (p = 0.006), when attempting to anticipate the patient’s reactions (p = 0.044), when the patient refused to receive information (p = 0.006), when they had to remain assertive and confident regardless of the patient’s response (p = 0.013), and when managing post-communication consequences (p = 0.012). Conclusion: The limited knowledge and application of specific tools for bad news communication could exacerbate stressful conditions at this sensitive time among healthcare providers. The present findings could be used by health institutions to develop ad hoc training programs for both physicians and nurses, as well as to strengthen their organizational culture.