Adaptação do protocolo SPIKES para a comunicação de más notícias no contexto da paliatividade hospitalar: estudo integrativo

Breaking bad news in the hospital setting is one of the most complex tasks in healthcare practice, requiring both technical expertise and empathetic communication from professionals facing reserved prognoses. This study aimed to construct a structured institutional protocol based on the SPIKES strategy for breaking bad news in the hospital environment, with a specific focus on palliative care. A qualitative methodological study was conducted, grounded in an integrative literature review guided by the PRISMA 2020 statement. The systematic search across scientific databases yielded a final sample of 27 studies published between 2020 and 2024. The results demonstrated that the rigid application of the traditional protocol presents limitations in the hospital palliative context, highlighting the need for prior multiprofessional alignment, patient cognitive assessment, bioethical management of the conspiracy of silence, clarity in prognostic transition, expanded support for anticipatory grief with bedside nursing involvement, and an explicit guarantee of non-abandonment through advance care directives. In conclusion, the systematization and adaptation of the protocol provide healthcare professionals with a practical and reliable tool capable of mitigating improvisation, reducing institutional conflicts, and promoting ethical, humanized, and patient-centered communication that honors the dignity of patients and their families.