Background: Breaking bad news (BBN) is challenging for patients and physicians. Physicians are usually poorly trained or untrained at all in BBN despite the existence of consensus protocols for BBN.
Objective: This study aimed to assess physicians' knowledge, attitude, and practice (KAP) regarding SPIKES protocol for BBN. 
Patients and Methods: This is a cross-sectional multicenter study carried out on 395 physicians of different specialties and workplaces in Fayoum Governorate, Egypt. Data were collected through a self-administered questionnaire consisting of three sections of questions about physicians: the background characteristics questions, questions assessing their knowledge regarding BBN, and questions assessing their attitude regarding SPIKES protocol for BBN. The attitude was assessed using the BBN attitude scale (BBNAS).
Results:  Only 24% of physicians ever received training on BBN and 10% knew about SPIKES protocol. Bad experience after BBN was reported by 52% of physicians. Most (75%) physicians preferred BBN to the patient's family rather than the patient. Physicians' agreement level with the SPIKES strategy was very high (91.8%). Agreement to the SPIKES protocol steps was statistically significantly higher among men, younger and older age groups (≤ 30 and > 40 years of age) physicians, psychologists and oncologists, and those who received previous training on BBN.
Conclusion: The majority of physicians highly agreed with the SPIKES strategy for BBN, but they lacked essential knowledge for BBN.  Specific training and standardized protocols in this regard deem to be necessary during medical school study and continuous professional development.