Among the 121 participants, half (n = 62, 51.2%) were male, and the median age [1st Q; 3rd Q] was 36 [32; 41.8] years. The median length of time in practice was 8 [5; 13.3] years overall and 3 [1; 7] years in the current department.

The majority (90.9%) were general practitioners with a smaller number of specialist physicians (n = 11, 9.1%), with almost two-thirds working in medicine, with the remainder working in surgery (17.4%); Gynecology and Obstetrics (14%), or Orthopedics (5.8%, see Table 1 for details).

Most participants (95.9%) correctly identified bad news (Q1) and a high percentage of them considered their ability to deliver bad news as acceptable (52.1%) or good (30.6%) (Q4) (Table 2).

Fifty-one (42.2%) respondents frequently or almost always communicate bad news (Q2), and only one (0.8%) stated he never did that task.

Most participants reported using verbal and non-verbal communication when delivering bad news (n = 76, 62.8%, Q3).

Almost two-thirds (61.2%) reported that they seek a private and comfortable place to deliver bad news, while just over a third (37.2%) use an available office, even if it provides less than ideal conditions (Q5). If the patient is bedridden, most of the participants stand near the bed (61.2%), and 38.8% sit on the bed when breaking bad news (Q6, Table 2).

When communicating bad news (n = 110, 90.9%, Q7), most participants reported using clear, understandable language and avoiding technical words, over half (n = 68, 56.2%) clarify patient’s concerns and a third (n = 42, 34.7%) tried to put themselves in the patient’s shoes. Regarding the diagnosis, prognosis, and treatment, most participants (n = 100, 82.6%, Q8) reported that they tell the truth cautiously and carefully according to the patient and/or family’s demand, while only a small part (n = 13, 10.7%) alluded that they never tell the truth.

Nearly half (48.8%) revealed that they communicate the bad news first to the patient and then to the family, while 37.2% communicate them first to the family (Q9, Table 2).

When listening to the patients and their questions, most participants preferred to listen carefully without interruptions (71.1%, Q10) and to spend the necessary time answering questions (66.9%). Although it is a part of a doctor’s role, they may not always feel available or capable of fulfilling this responsibility. Most participants (70%) working in Surgery (n = 16, 76.2%) and Medicine (n = 55, 72.4%) departments were available to answer the patient’s questions and only a third (n = 6, 35.3%) of those working in the Gynecology and Obstetrics were available to undertake this task. In the conversation with the patient, the topics most addressed by the participants are (Q11): understanding what the patients know about their health condition (n = 97, 80.2%) and what concerns them (n = 87, 71.9%). The lowest percentages of participants that explore patient’s concerns are found in the departments of Gynecology and Obstetrics (n = 8, 47.1%) and Surgery (n = 13, 61.9%).

Most participants also reported providing support to the patient and the family, either in the instrumental (n = 83, 68.6%), informational (n = 100, 82.6%), emotional (n = 96, 79.3%) and spiritual (n = 83, 68.6%) aspects (Q14, Table 3). Note that instrumental support is helping in a practical way, through material support, like providing home care to assist in the patient’s daily activities [31].

There was no association between gender and to whom the participants give their instrumental (p = 0.453), informational (p = 0.518), emotional (p = 0.888), and spiritual (p = 0.926) support. In addition, no statistical differences were found between the time of medical practice and to whom they give their instrumental (p = 0.421), informational (p = 0.366), emotional (p = 0.641), and spiritual (p = 0.959) support.

Regarding the frequency of communicating bad news, significantly more female participants were likely to do it more frequently than male participants (U = 1319; p = 0.003). No significant correlation was found between how often participants deliver bad news and age (r = -0.033, p = 0.717).

Concerning the way participants break bad news (only verbal or both verbal and non-verbal communication), no significant differences were found between: gender (\(^\)(1) = 0.126, p = 0.723), time since graduation (U = 1378, p = 0.190) or departments (p = 0.518) of the participants.

No significant differences were found between genders and the place where participants communicate bad news (p = 0.784), or if standing beside the bed when the patient is bedridden (\(^\)(1) = 0.163, p = 0.686). Regarding the number of years of practice, no significant differences were found between those who communicate bad news sitting and those who do so standing next to the bed of a bedridden patient (U = 1307, p = 0.054). However, participants who were looking for a private and comfortable place to break bad news were in the profession for significantly more years than those who searched for an available office (median [1st Q; 3rd Q] of 10 [6, 17] versus 7 [3.5, 10.5], U = 1092, p = 0.002).

Almost half of the participants (n = 56, 47.9%), reported that they feel sad when communicating bad news, nevertheless 28.2% feel that they have fulfilled their duty (Q12). About fears (Q13), the majority of participants (n = 80, 66.1%) indicated that they fear the patient’s reactions and that they are afraid of shattering the patient’s hope (n = 73, 60.3%, Table 4).

Regarding education on the communication of bad news, a third of the participants reported that they learned to communicate bad news during their medical degree, while a fourth stated they did so by observing their medical colleagues in clinical practice. However, there were still participants who indicated that they cannot break bad news (n = 30, 24.8%) (Q15, Table 4). Almost all of the participants (n = 114, 94.2%) did not know any instrument to assist in the development of this skill (Q16, Table 4). No significant differences were found in the distribution of age and years of practice in relation to knowledge or ignorance about instruments that can assist in this task (U = 286, p = 0.226, and U = 285.5, p = 0.547, respectively, Q16).

In addition, most participants (n = 85, 70.2%), believe that is very important to address the communication of bad news during higher education, and 27.3% consider it important (Q17). Concerning the address of this theme in training, 79.3% of the participants see that as very important and 19% as important (Q18, Table 4).