title: The P-A-C-I-E-N-T-E Protocol: An instrument for breaking bad news adapted to the Brazilian medical reality.
abstract: OBJECTIVE
  There are plenty of published tools for breaking bad medical news; however, none of them is culturally appropriate to our reality or published in the Brazilian literature. This study proposes a genuinely Brazilian communication tool and evaluates its acceptance among doctors and nurses.
  
  
  METHODS
  This was a prospective study. The data were collected after specific training of doctors and nurses on the bad news communication techniques based on the P-A-C-I-E-N-T-E ("patient," in Portuguese) Protocol. This instrument is in accordance with the Brazilian reality and was based on the SPIKES communication tool.
  
  
  RESULTS
  The worst task to be performed during communication is "talking about death" followed by "discussing the end of curative treatment attempts" and "diagnosis" itself. Among the respondents, 48% reported they did not receive formal training for communicating. Also, 52% of respondents do not use any systematic approach in their daily practice when communicating with patients, but 97% considered the proposed P-A-C-I-E-N-T-E Protocol as a useful and appropriate communication tool.
  
  
  CONCLUSIONS
  The P-A-C-I-E-N-T-E Protocol proved to be suitable to the Brazilian context.
authors.affiliation: Pontifícia Universidade Católica, Sorocaba, SP, Brazil.
authors.forename: Carolina Rebello
authors.initials: CR
authors.lastname: Pereira
authors.affiliation: Anesthesiology Graduate Program, Faculdade de Medicina de Botucatu, Unesp, Botucatu, SP, Brazil.
authors.forename: Marco Antônio Marchetti
authors.initials: MA
authors.lastname: Calônego
authors.affiliation: Department of Anesthesiology, Faculdade de Medicina de Botucatu, Unesp, Botucatu, SP, Brazil.
authors.forename: Lino
authors.initials: L
authors.lastname: Lemonica
authors.affiliation: Department of Anesthesiology, Faculdade de Medicina de Botucatu, Unesp, Botucatu, SP, Brazil.
authors.forename: Guilherme Antonio Moreira de
authors.initials: GA
authors.lastname: Barros
mesh_terms: D000004:Abbreviations as Topic; D000328:Adult; D001291:Attitude of Health Personnel; D001938:Brazil; D003142:Communication; D054521:Cultural Competency; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D011446:Prospective Studies; D014342:Truth Disclosure