Patient-Focused Communication Practices of Nigerian Medical Officers When Conveying Adverse Diagnoses: An Integrative Narrative Review and Context-Sensitive Practice Framework

Abstract

Conveying an adverse diagnosis is among the most ethically sensitive and emotionally demanding duties of medical practice. In Nigeria, adverse diagnosis communication occurs within a pluralistic health system marked by family involvement, religious meaning-making, language diversity, variable health literacy, resource constraints, and hierarchical doctor-patient relations. Although structured breaking-bad-news models such as SPIKES are widely cited, the extent to which these models are patient-focused and contextually adapted in Nigerian practice remains an important scholarly and clinical question. This article synthesised current evidence on patient-focused communication practices among Nigerian medical officers and related physician groups when conveying adverse diagnoses and proposed a context-sensitive framework for improving disclosure practice, training, and institutional support. An integrative narrative review was conducted using accessible peer-reviewed and policy-relevant literature on breaking bad news, patient-centered communication, Nigerian doctor-patient interaction, and communication barriers in sub-Saharan African clinical settings. Evidence was synthesized thematically around protocol use, patient autonomy, family and cultural mediation, emotional support, religious/spiritual considerations, health-system constraints, and communication training. The reviewed evidence suggested that Nigerian doctors increasingly recognized the importance of structured, patient-focused disclosure. A recent cross-sectional study among 245 Nigerian doctors reported 72.7% full adherence to SPIKES, with very high reported adherence to knowledge sharing, setting, empathy, and strategy, but weaker adherence to invitation, which concerns how much information the patient wishes to receive (Ipinnimo et al., 2025). A qualitative study of Nigerian clinical oncologists found that breaking cancer news was overwhelming, required individualized communication, should keep the patient as the primary focus, and was constrained by workload and insufficient training (Okoye et al., 2024). Broader Nigerian communication research indicated that clinical encounters may remain doctor-centered because of power distance, limited disclosure depth, insufficient empathy, and institutional weaknesses in patient-centered care (Adam, 2014; Adebayo, 2021; Akinkurolere, 2022; Lateef & Mhlongo, 2022). The synthesis led to the development of RESPECT-NG, a six-domain framework: Readiness and setting; Explore perception and disclosure preference; Share knowledge plainly; Pause for emotion, family, and spiritual meaning; Enable decisions and next steps; and Continuity, team support, and navigation. Patient-focused adverse diagnosis communication in Nigeria requires more than technical delivery of diagnostic information. It requires ethically grounded, culturally responsive, emotionally supportive, and system-enabled communication. The proposed RESPECT-NG framework may inform medical education, continuing professional development, hospital policy, and future empirical research on adverse diagnosis disclosure in Nigeria.