Breaking Bad News in Nigerian Clinical Settings: Assessment of Practices, Competence, and Associated Factors among Physicians

Abstract

Back ground : Breaking bad news is a demanding part of clinical work, and how it is delivered can shape patient trust, cooperation, and overall experience. In many low- and middle-income countries, including Nigeria, physicians often have limited formal preparation for this task. This study explored how Nigerian physicians currently deliver bad news, how well they follow the SPIKES protocol, and the barriers they face. Methods : A descriptive cross-sectional survey was carried out among physicians attending the 2022 Nigerian Medical Association Annual Conference. Using a structured questionnaire, the study gathered information on demographic characteristics, breaking-bad-news practices, adherence to SPIKES, and perceived challenges. Data from 183 respondents were analyzed using SPSS, with descriptive and chi-square statistics applied. Results : Most participants were male consultants working in tertiary hospitals. Notably, 38.8% had received no formal training in breaking bad news, a significant gap for such a core clinical skill; the remaining 61.2% had received some form of prior training. Nearly all had communicated bad news during their careers, yet 41% recalled negative outcomes linked to poor delivery. Although there was strong support for formal training and willingness to attend future sessions, only about 60% reported consistent use of the SPIKES protocol. Key barriers included insufficient training, lack of time, emotional strain, language difficulties, and long work hours. Competence was not significantly associated with professional experience or cadre. Conclusion : The study underscores an ongoing need to embed structured communication training, including SPIKES, into medical education and continuous professional development. The persistent gap in formal training—with nearly four in ten physicians lacking it—highlights that progress remains incomplete. Improving these skills could promote more patient-centered care and better emotional outcomes in clinical practice.