Background: Breaking bad news is an unpleasant task for physicians, especially for patients with cancer.
In this regard, the SPIKES protocol, which is prevalent in several countries, has not been discussed in Iran.
Objectives: This study evaluated how the SPIKES protocol was followed by physicians. 
Materials & Methods: This descriptive cross-sectional study was conducted at Guilan academic
hospitals from December 2021 to April 2022. Patients with cancer participated in the survey who were
referred to the oncology academic centers for follow-ups or radiotherapy and chemotherapy. They were
over 18 years old with the ability of proper communication. The SPIKES questionnaire consists of 12
questions with 6 subscales (settings, invitation, perception, knowledge, emotion, and strategy). It was
filled out through a direct interview.
Results: The data from 280 patients were analyzed. Everyone stated that at the time of receiving the
diagnosis, the doctor was not in a hurry and made appropriate eye contact. About 61.1% believed they
were emotionally supported, and 65.4% were satisfied with their final knowledge about the disease and
treatment planning. Patients with older ages and lower levels of education were significantly more likely
to state that physicians’ language was not comprehensive; physicians did not understand them, and the
patients were not emotionally supported (P=0.0001).
Conclusion: This study showed that more attention should be paid to older patients with lower levels of
education. They needed more time for conversation and simpler dialect. Some areas, such as “invitation”
are required to be improved.

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