Designing a SPIKES-based protocol for communicating uncertainty in indeterminate thyroid cytology: a mixed-method analysis within a pilot study.

Indeterminate thyroid cytology presents a significant diagnostic challenge, often leading to difficult treatment decisions for both physicians and patients. Effective communication of these uncertainties is crucial, especially in a surgical setting, where decisions can have long-lasting impacts. This is particularly important for younger surgeons who may lack extensive clinical experience. This study aimed to plan, develop, implement, and pilot a communication protocol designed for surgeons, particularly those in training, to navigate uncertainty and build trust with their patients. Additionally, it documented the reactions of patients managed using this approach. Fifty-two patients diagnosed with indeterminate thyroid cytology were enrolled between March 2023 and January 2024 at the Endocrine Surgery Unit of "Azienda Ospedialiera Universitaria Policlinico Umberto I" in Rome, Italy. A communication protocol based on the SPIKES model (Setting, Perception, Invitation, Knowledge, Emotion, Strategy), a six-step protocol for guiding  difficult conversations, was designed to structure discussions around uncertain diagnoses. Patient consultations were conducted in three phases: the initial outpatient visit, pre-surgery admission, and a follow-up one week after surgery. During each encounter, patients' emotional responses were recorded using open-ended questions. To ensure clarity, a Decision Aid (DA) tool was introduced during the K-Knowledge phase of SPIKES, to better explain the risks and treatment options. A mixed-methods approach was used to analyze both qualitative and quantitative data from patient feedback. The adapted protocol was found to be effective in enhancing patient comprehension and emotional response. Approximately 80% of patients reported emotional relief after the first consultation, and by the third encounter, 91% expressed a sense of well-being or trust. The most frequently reported emotional states across all three encounters were serenity, reassurance, and trust. A small subset of patients continued to experience concern or fatigue. Additionally, 96% of participants rated the communication as clear, and 88.5% considered the final therapeutic decision as the correct one. This pilot study suggests that a structured SPIKES-based communication protocol can help address gaps in patient understanding, trust, and satisfaction when managing indeterminate thyroid cytology. Implementing such protocols may streamline communication in surgical settings, improve  patient-centered care, and support physicians, particularly trainees, in managing complex patient interactions.