Document Type : Review Article
Authors
1
Medical Oncologist, Hematologist, and Stem Cell Transplantation Specialist, Department of Hematology and Oncology, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
2
Pediatric Hematology and Oncology, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
10.22034/meb.2026.600513.1142
Abstract
Background: Breaking bad news (BBN) is a complex oncology communication competency requiring clinicians to convey information, assess patient preferences, respond to emotions, involve families appropriately, and plan ongoing care. Because BBN is often taught informally, this study examined educational approaches and the challenges of culturally adapting them within Iran’s medical education system.
Materials and Methods: In this scoping review, we followed the Joanna Briggs Institute framework and PRISMA-ScR guidance and searched PubMed/MEDLINE, Scopus, Web of Science, ERIC, SID, Magiran, and Google Scholar from inception through July 2025. Search terms covered BBN, oncology, communication training, SPIKES, SHARE, OncoTalk, simulation, standardized patients, role-play, and cultural adaptation. Evidence was charted and synthesized descriptively and thematically.
Results: BBN education combines structured communication frameworks with interactive methods. SPIKES provides a stepwise structure for difficult conversations; SHARE emphasizes patient preferences and emotional support; and OncoTalk represents skills-based training through practice and feedback. Approaches included standardized-patient simulation, peer role-play, workshops, video feedback, and debriefing. These approaches generally improved selected observable behaviors, including open questioning, empathy, and responses to emotional cues. However, evidence on long-term retention, clinical transfer, patient-reported outcomes, satisfaction, and burnout remained limited or heterogeneous. In Iran, key challenges included variation in disclosure preferences, family involvement, emotional and spiritual concerns, limited time and privacy, insufficient practice, inadequate faculty preparedness, and limited curricular integration.
Conclusion: BBN education should combine structured frameworks with experiential methods. In Iran, adaptation must address patient preferences, family involvement, language, cultural context, organizational conditions, and curricular capacity while protecting patients’ rights to information and participation. Long-term intervention studies using validated performance assessments are needed to evaluate effectiveness, feasibility, skill retention, clinical transfer, and patient-centered outcomes.
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