Original Article

Breaking HIV News to Clients: SPIKES Strategy in Post-Test Counseling Session


Breaking bad news is one of the most burdensome tasks physicians face in their everyday practice. It becomes even more challenging in the context of HIV+ patients because of stigma and discrimination. The aim of the current study is to evaluate the quality of giving HIV seroconversion news according to SPIKES protocol. Numbers of 154 consecutive HIV+ patients from Imam Khomeini Hospital testing and counseling center were enrolled in this study. Patients were inquired about how they were given the HIV news and whether or not they received pre- and post-test counseling sessions. Around 51% of them were men, 80% had high school education, and 56% were employed. Regarding marital status, 32% were single, and 52% were married at the time of the interview. Among them, 31% had received the HIV news in a counseling center, and only 29% had pre-test counseling. SPIKES criteria were significantly met when the HIV news was given in an HIV counseling and testing center (P.value<0.05). Low coverage of HIV counseling services was observed in the study. SPIKES criteria were significantly met when the HIV seroconversion news was given in a counseling center. The need to further train staff to deliver HIV news seems a priority in the field of HIV care and treatment.

Fallowfield L, Jenkins V. Communicating sad, bad, and difficult news in medicine. The Lancet. 2004;363(9405):312-9.

Buckman R. Breaking bad news: why is it still so difficult? British medical journal (Clinical research ed). 1984;288(6430):1597.

Cegala DJ, Lenzmeier Broz S. Physician communication skills training: a review of theoretical backgrounds, objectives and skills. Medical education.2002;36(11):1004-16.

Tavakol M, Torabi S, Lyne OD, Zeinaloo AA. A quantitative survey of intern's knowledge of communication skills: an Iranian exploration. BMCmedical education. 2005;5(1):6.

Fallowfield L, Jenkins V. Effective communication skills are the key to good cancer care. European Journal of Cancer. 1999;35(11):1592-7.

Barnett MM. Effect of breaking bad news on patients' perceptions of doctors. Journal of the Royal Society of Medicine. 2002;95(7):343-7.

Crawford AM. Stigma Associated With AIDS: A Meta Analysis1. Journal of Applied Social Psychology. 1996;26(5):398-416.

Laryea M, Gien L. The Impact of HIV-PositiveDiagnosis on the Individual, Part 1 Stigma, Rejection,and Loneliness. Clinical Nursing Research. 1993;2(3):245-63.

Greeff M, Phetlhu R, Makoae LN, et al. Disclosure of HIV status: experiences and perceptions of persons living with HIV/AIDS and nurses involved in their carein Africa. Qualitative Health Research. 2008;18(3):311-24.

Mill JE. Shrouded in secrecy: breaking the news of HIV infection to Ghanaian women. Journal of Transcultural Nursing. 2003;14(1):6-16.

Wanyenze RK, Hahn JA, Liechty CA, et al. Linkage to HIV care and survival following inpatient HIV counseling and testing. AIDS and Behavior. 2011;15(4):751-60.

Baile WF, Buckman R, Lenzi R, et al. SPIKES—a sixstep protocol for delivering bad news: application to thepatient with cancer. The oncologist. 2000;5(4):302-11.

Parker PA, Baile WF, de Moor C, et al. Breaking bad news about cancer: patients’ preferences for communication. Journal of Clinical Oncology. 2001;19(7):2049-56.

Ptacek J, Ptacek JJ. Patients’ perceptions of receiving bad news about cancer. Journal of Clinical Oncology. 2001;19(21):4160-4.

Mitsuya H. Telling the Truth to Cancer Patients and Patients with HIVS1 Infection in Japan. Annals of the New York Academy of Sciences. 1997;809(1):279-89.

Ishaque S, Saleem T, Khawaja F, et al. Breaking bad news: exploring patient's perspective and expectations. JPMA The Journal of the Pakistan Medical Association. 2010;60(5):407.

Cusick L. The process of disclosing positive HIV status: findings from qualitative research. Culture, Health & Sexuality. 1999;1(1):3-18.

IssueVol 54, No 5 (2016) QRcode
SectionOriginal Article(s)
Breaking bad news HIV counseling and testing SPIKES

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Emadi-Koochak H, Yazdi F, Haji Abdolbaghi M, Salehi MR, Shadloo B, Rahimi-Movaghar A. Breaking HIV News to Clients: SPIKES Strategy in Post-Test Counseling Session. Acta Med Iran. 2016;54(5):313-317.