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

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.