Physician’s attitude and practice to disclosure of cancer diagnosis to patients in Jos University Teaching Hospital North Central Nigeria

Abstract

Background: As the prevalence of malignancies increases worldwide in general and in Nigeria in particular, clinicians are faced with the responsibility of disclosing life altering information to their patients about cancer. How this is disclosed often has implications on subsequent management.

Objectives: The aim of this study was to assess the attitude and practice of clinicians in Jos University Teaching Hospital on disclosure of cancer diagnosis to patients.

Methods: This was a cross-sectional study of 169 clinicians across 9 clinical departments practicing in Jos University Teaching Hospital (JUTH) between April to May 2017. The responses on attitude and practice were scored based on a six step SKIPES protocol on delivering bad news. A minimum sample size of 100 was calculated but increased to 150 to compensate for non-responders. The questionnaires were administered at duty posts of doctors. Simple percentages were used to describe responses on attitude and practice and Fisher‟s exact test was used to analyze contingency tables. The data were analyzed using SPSS version 16.0.A p value of 0.05 was used to test for significance.

Results: Most of the respondents were clinicians in the departments of Surgery 37(21.9%) and Obstetrics and Gynaecology 35(20.7%). Registrars were in the majority in the responders (55%), senior registrars were 26% and consultants made up 18.9% of the respondents. The mean age of respondents was 36.90±6.68, 77% of the respondents frequently treated malignancies while 55% treated malignancies occasionally and 2.4 % had never treated malignancies. 99.4% felt patients should be informed about a diagnosis of cancer before treatment and 69.8% felt it was the responsibility of the managing consultant to disclose cancer diagnosis to patients while 30.2% felt senior registrars should do so. Nearly 80%( 78.1% )felt they were capable of disclosing cancer diagnosis yet a majority (88.8%) felt they required training on breaking of bad news to patients with a significant number of those who felt they required training on breaking of bad Jos Journal of Medicine. Volume 15, No. 1, 42-49 news were under 50 years of age p=0.012.More of the disclosure (56.8%) was done at bedside  and 43.2% was in the clinic.

Conclusion: Physician‟s attitude and practice of the protocols for disclosure of cancer diagnosis were generally satisfactory but a  statistically significant number under the age of 50 years  acknowledged their need for additional training on this skill.