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

Plain English summary

Breaking bad news in an assisted reproductive context can be a frequent occurrence due to low rates of success. Clinicians are often unprepared to manage this kind of communication, as literature on assisted reproductive technology (ART) lacks specific guidelines for managing difficult conversations, unlike in oncology where the six-step (SPIKES) Buckman Protocol was developed. The present study aimed to explore the applicability of the SPIKES Protocol to the ART context through a focus group of ART experts (7 gynecologists; 4 psychologists; 1 biologist; 1 obstetrician). First of all, participants completed the Critical Incidents Report (CIR) to describe the experience of delivering bad news. Thereafter, a focus group with ART experts together with an expert in health communication and a patient was conducted. Group discussion of CIRs was the starting point of the focus group, followed by discussion about the applicability of the SPIKES Protocol to ART. The discussion was audio-taped, transcribed and analyzed with qualitative content analysis.

This study found that the SPIKES Protocol fit ART consultations, even if the definition of bad news was found to be more controversial than in oncology, due to the fact that the ability to conceive was closely related to personal identity. The discussion of Buckman’s six-steps pointed out some specificities of the ART context, such as: telephone communication in the setting; the necessity to balance patients’ expectations with the need to be honest; the importance to integrate clinical aspects with psychosocial ones; the need to manage patients’ anger; the importance to help couples accept the clinical situation.