Using the SPIKES protocol to deliver prognostic information on ambulation potential after complete spinal cord injury: Effects on coping strategies

CONTEXT/OBJECTIVE: Delivering prognostic information about ambulation after spinal cord injury (SCI) is a sensitive yet essential responsibility. This study aimed to evaluate the effect of the SPIKES protocol on coping strategies in individuals with neurologically complete SCI, and to explore their experiences and expectations regarding breaking bad news (BBN) in Turkey. DESIGN: Matched comparative study. SETTING: Tertiary-level SCI rehabilitation clinic. PARTICIPANTS: Twenty-five individuals with neurologically complete SCI were included in the intervention group and received prognostic information using the SPIKES protocol. Twenty-seven matched controls who had completed inpatient rehabilitation at other centers were included for comparison. INTERVENTIONS: Structured delivery of ambulation prognosis using the SPIKES protocol. OUTCOME MEASURES: Coping strategies were assessed using the Spinal Cord Lesion-Related Coping Strategies Questionnaire (SCL-CSQ). RESULTS: 94.2% of all participants expressed a desire to receive prognostic information even if unfavorable, with 36.7% preferring to receive it during acute care. Participants' expectations did not differ by demographic characteristics (P > 0.05). Individuals with paraplegia showed a higher preference to receive information regarding ambulation prognosis during acute care than individuals with tetraplegia (45.7% vs. 14.3%; P = 0.039). Participants in the SPIKES group demonstrated higher acceptance, fighting spirit, and total coping scores than controls (P < 0.05), with no significant difference in social reliance. CONCLUSION: Most individuals with neurologically complete SCI preferred to receive prognostic information, even when unfavorable. In this pilot study, structured communication using the SPIKES protocol was associated with more adaptive coping strategies; further studies are warranted to confirm these findings.