Table 3 Synthesis of the specificities in the ART context for each step of the SPIKES Protocol

DEFINITION OF BAD NEWS [38]

SPECIFITIES OF ART CONTEXT

“Any information which adversely and seriously affects the patient’s view of his or her future”

→ reiteration of bad news

→ the “patient” is a couple

→ there is not a disease to cure

→existential failure for the couple

→ professional failure for the clinicians (“no enemy, no healing”)

SIX STEPS [22, 23]

SPECIFITIES OF ART CONTEXT

Setting up

→ communication by telephone

→ communication as a two- step process

Patient Perception

→ difficulty in managing the lack of information and/or the misinformation

Invitation

→ difficulty in balancing the couple desires to know with the clinicians’ need to be clear

→ besides what the couple wants to know, establishing what the patients have to know

Knowledge

→ joining the medical aspects of communication with the psycho-social ones

→ allowing patients to feel active and reduce their sense of powerlessness

Emotions

→ anger as the most difficult reaction to manage

Strategy and Summary

→ giving back to the couple a new meaning of the ART experience and an opportunity to grow