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Designing a SPIKES-based protocol for communicating uncertainty in indeterminate thyroid cytology: a mixed-method

Rossella Melcarne1, Fabrizio Consorti2, Giorgio Grani3

  • 1Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy. rossella.melcarne@uniroma1.it.

Updates in Surgery
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Summary

A new communication protocol for indeterminate thyroid cytology significantly improved patient understanding and trust. This structured approach, particularly beneficial for surgical trainees, enhanced patient-centered care and satisfaction with treatment decisions.

Keywords:
Patient-centered careRiskShared decision makingSoft skillsSurgery residencyThyroid nodules

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Area of Science:

  • Endocrine Surgery
  • Surgical Communication
  • Patient-Centered Care

Background:

  • Indeterminate thyroid cytology poses diagnostic challenges, impacting treatment decisions and physician-patient communication.
  • Effective communication is vital, especially for surgical trainees managing patient uncertainty and building trust.
  • Existing communication strategies may not adequately address the complexities of uncertain thyroid diagnoses.

Purpose of the Study:

  • To develop, implement, and pilot a communication protocol for surgeons managing indeterminate thyroid cytology.
  • To assess the protocol's impact on patient understanding, emotional response, and trust.
  • To document patient reactions to a structured communication approach during surgical consultations.

Main Methods:

  • A SPIKES (Setting, Perception, Invitation, Knowledge, Emotion, Strategy) model-based communication protocol was designed.
  • Fifty-two patients with indeterminate thyroid cytology participated in a pilot study involving three consultation phases.
  • A Decision Aid tool was integrated into the protocol; patient emotional responses and feedback were collected using mixed methods.

Main Results:

  • The protocol enhanced patient comprehension and emotional response, with 80% reporting relief after the first consultation.
  • By the third encounter, 91% of patients expressed well-being or trust, with serenity and reassurance being common emotions.
  • High ratings for communication clarity (96%) and therapeutic decision correctness (88.5%) were reported.

Conclusions:

  • A structured SPIKES-based communication protocol effectively addresses patient understanding and trust in managing indeterminate thyroid cytology.
  • The protocol supports physicians, particularly trainees, in navigating complex patient interactions in surgical settings.
  • Implementation can streamline communication, improve patient-centered care, and enhance satisfaction with treatment outcomes.