Designing a SPIKES-Based Protocol for Communicating Uncertainty in Indeterminate Thyroid Cytology: A Mixed-method Analysis within a Pilot Study

Introduction: 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. Objective: 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 documents the reactions of an initial patient cohort to this approach. Methods: Fifty-two patients diagnosed with TIR3 were enrolled between March 2023 and January 2024 at the Endocrine Surgery Unit. A communication protocol, based on the SPIKES model, 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 facilitate understanding, 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. Results: The adapted protocol was found to be effective, with most patients expressing trust and satisfaction regarding the chosen therapeutic option in collaboration with their surgeon. However, some patients reported lingering anxiety about their treatment and an incomplete understanding of the therapeutic process by the end of the protocol. Conclusion: 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, enhance patient-centered care, and support physicians, particularly trainees, in managing complex patient interactions.