Family Conferences for Communicating Difficult News by Medical Residents Through the Lens of the SPIKES Protocol

Family Conferences for Communicating Difficult News by Medical Residents Through the Lens of the SPIKES Protocol | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Family Conferences for Communicating Difficult News by Medical Residents Through the Lens of the SPIKES Protocol Milena David Narchi, Rika Miyahara Kobayashi, Maria do Patrocinio Tenorio Nunes This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8339327/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Introduction: Communicating difficult news is a core physician responsibility, and the family conference (FC) is a structured strategy designed to alleviate patient and family suffering, clarify diagnosis and prognosis, and support shared decision-making. Objectives To describe audio-recorded FCs conducted by second-year Internal Medicine residents (IMR2) with patients facing incurable or serious illnesses and their families. Specific aims included observing residents’ performance, identifying communication competencies and gaps, and proposing strategies to improve the delivery of difficult news. Methods A qualitative, observational, cross-sectional study involving 16 IMR2s during their General Ward internship (GW). Audio-recorded FCs were transcribed verbatim and independently analyzed by two evaluators. Data collection occurred between February 2020 and March 2023. Content analysis was guided by Bardin’s framework and interpreted using the Setting–Perception–Invitation–Knowledge–Emotions–Strategy (SPIKES) model. The study was approved by the institutional Research Ethics Committee (IREC Protocol No. 12352; CAEE: 34776120.3.0000.0068). Results The mean age of residents was 26.9 years, and 93.8% reported previous experience with FCs. Training experiences included didactic sessions, role-playing, and simulation. Although most residents followed the structural steps of the SPIKES model, limitations were identified in emotional management and empathic validation. Conclusions The findings highlight gaps in communication and emotional coping skills among residents, underscoring the need for structured educational interventions, multidisciplinary support, and validated assessment tools to strengthen difficult news communication within medical education. Difficult news communication Family conference SPIKES protocol Medical residency Palliative care Medical education Internal medicine Full Text Additional Declarations No competing interests reported. Supplementary Files Additionalfile1QuestionnaireBMC.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 26 Jan, 2026 Reviewers agreed at journal 23 Jan, 2026 Reviewers invited by journal 20 Jan, 2026 Editor assigned by journal 19 Jan, 2026 Editor invited by journal 30 Dec, 2025 Submission checks completed at journal 29 Dec, 2025 First submitted to journal 29 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8339327","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":577752168,"identity":"b5b0789a-2b82-4a70-9062-e21764f5cc4d","order_by":0,"name":"Milena David Narchi","email":"","orcid":"","institution":"University of Sao Paulo, School of Medicine,","correspondingAuthor":false,"prefix":"","firstName":"Milena","middleName":"David","lastName":"Narchi","suffix":""},{"id":577752169,"identity":"5374ffb1-a364-41fe-868b-b98b3f429a1a","order_by":1,"name":"Rika Miyahara Kobayashi","email":"","orcid":"","institution":"Instituto Dante Pazzanese 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Protocol","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Difficult news communication, Family conference, SPIKES protocol, Medical residency, Palliative care, Medical education, Internal medicine","lastPublishedDoi":"10.21203/rs.3.rs-8339327/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8339327/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e \u003cp\u003eCommunicating difficult news is a core physician responsibility, and the family conference (FC) is a structured strategy designed to alleviate patient and family suffering, clarify diagnosis and prognosis, and support shared decision-making.\u003c/p\u003e\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eTo describe audio-recorded FCs conducted by second-year Internal Medicine residents (IMR2) with patients facing incurable or serious illnesses and their families. Specific aims included observing residents\u0026rsquo; performance, identifying communication competencies and gaps, and proposing strategies to improve the delivery of difficult news.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA qualitative, observational, cross-sectional study involving 16 IMR2s during their General Ward internship (GW). Audio-recorded FCs were transcribed verbatim and independently analyzed by two evaluators. Data collection occurred between February 2020 and March 2023. Content analysis was guided by Bardin\u0026rsquo;s framework and interpreted using the Setting\u0026ndash;Perception\u0026ndash;Invitation\u0026ndash;Knowledge\u0026ndash;Emotions\u0026ndash;Strategy (SPIKES) model. The study was approved by the institutional Research Ethics Committee (IREC Protocol No. 12352; CAEE: 34776120.3.0000.0068).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe mean age of residents was 26.9 years, and 93.8% reported previous experience with FCs. Training experiences included didactic sessions, role-playing, and simulation. Although most residents followed the structural steps of the SPIKES model, limitations were identified in emotional management and empathic validation.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe findings highlight gaps in communication and emotional coping skills among residents, underscoring the need for structured educational interventions, multidisciplinary support, and validated assessment tools to strengthen difficult news communication within medical education.\u003c/p\u003e","manuscriptTitle":"Family Conferences for Communicating Difficult News by Medical Residents Through the Lens of the SPIKES Protocol","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-22 16:26:24","doi":"10.21203/rs.3.rs-8339327/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-01-27T00:39:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"232114421603753123583179414895410308499","date":"2026-01-24T01:36:41+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-20T11:27:04+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-19T08:54:36+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-30T05:25:59+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-29T19:35:46+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-12-29T19:30:33+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3e57b899-471c-4204-aa71-8733601f55b3","owner":[],"postedDate":"January 22nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-22T16:26:24+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-22 16:26:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8339327","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8339327","identity":"rs-8339327","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}