Dear Editor 
In the last century، more than 2. 6 billion people in the world have been affected by natural disasters، such as earthquakes، floods، storms، landslides، and climate changes [1]. In developing countries، more than 90% of deaths are caused by accidents and disasters. Iran is one of the countries prone to natural disasters in the world، where approximately 90% of its population is exposed to natural disasters [2]. During the past three decades، natural disasters in Iran have killed 2، 689 people annually، and have caused an economic loss by 737، 058 thousand dollars [3]. The delivery of bad news after natural disasters is one of the responsibilities of therapists. The bad news refers to any information that cause negative changes in a patient's view of the future [4]. The delivery of bad news is a very complicated process that starts from the stage before delivery and continues for a long time after delivery. If it is not done well، it can cause stress for a long time which will put the person's health at risk. The delivery of bad news to the patients requires the participation of a group of health care providers، and it should not be the responsibility of only one member of the medical team [5, 6]. The delivery of bad news includes two steps؛ first، using appropriate words and terms understandable for the patient and family، and then evaluating their reaction [7]. In 1992، Buckman proposed a SPIKES protocol for delivering bad news which includes the following six steps: Choosing the right setting to deliver bad news (setting interview)، evaluating the patient's perception of the current situation (perception، declaring the intention to give bad news (invitation)، finding out how much the patient needs to receive information (knowledge)، responding to the patient's feelings (empathy/emotion)، and making sure that the patient understood the news correctly، and developing a strategy for the next steps (summary/strategy) [8].
Based on the destruction level and lack of economic resources، people's psychological pressure increases after natural disasters and their capacity to receive bad news decreases؛ therefore، they show unfortunate mental conditions after hearing the news about the death of loved ones [9]. The delivery of bad news requires special care [7]. Cultural and religious context have a important effect on the attitude and skills regarding the delivery of bad news [10]. The lack of providing necessary cultural training to the therapists، lack of training for breaking bad news in urgent situations، and lack of psychosocial support for the patient are among the challenges of delivering bad news in Iran [11]. It is not possible to use the same protocol to deliver bad news for all situations. It is necessary to localize or develop the Persian version of the SPIKES protocol to break bad news during natural disasters in Iran، and it is recommended to be included in the emergency response plan. Such protocol can be used in line with the activity and evaluation of the validity criterion of "breaking bad news to the patient/legal guardian by the ethical principles and predetermined methods"، and also for the use of pre-hospital and hospital cares. 


References

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