Indigenous perspectives on breaking bad news: ethical considerations for healthcare providers

Most healthcare providers (HCPs) work from ethical principles based on a Western model of practice that may not adhere to the cultural values intrinsic to Indigenous peoples. Breaking bad news (BBN) is an important topic of ethical concern in health research. While much has been documented on BBN globally, the ethical implications of receiving bad news, from an Indigenous patient perspective in particular, is an area that requires further inquiry. This article discusses the experiences of Māori (Indigenous peoples of New Zealand) lung cancer patients and their families, in order to investigate the ethical implications of receiving bad news. Data collection occurred through 23 semistructured interviews and nine focus groups with Māori lung cancer patients and their families in four districts in the Midland Region of New Zealand: Waikato, Bay of Plenty, Lakes and Tairāwhiti. The findings of this study were categorised into two key themes: communication and context. Avenues for best practice include understanding the centrality of the HCP–patient relationship and family ties in the healthcare journey, and providing patients with the full range of viable treatment options including hope, clear advice and guidance when the situation calls for it. Overall, the findings of this study hold implications for providing culturally safe and humanistic cancer care when BBN to Māori and Indigenous patients.

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Breaking Bad News: Preferences of Cancer Patients in Saudi Arabia

Journal of Palliative Care & Medicine ◽

10.4172/2165-7386.1000207 ◽

2015 ◽

Vol 05 (02) ◽

Cited By ~ 2

Author(s):

Syed Mustafa Karim

Keyword(s):

Saudi Arabia ◽

Cancer Patients ◽

Bad News ◽

Breaking Bad News ◽

Breaking Bad

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Breaking bad news: Comparison of perspectives of Middle Eastern cancer patients and their relatives.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.9568 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 9568-9568

Author(s):

Jamal M Zekri ◽

Syed Mustafa Karim ◽

Sawsan Bassi ◽

Bakr M Bin Sadiq ◽

Ehab Esmat Fawzy ◽

...

Keyword(s):

Cancer Patients ◽

Adverse Outcome ◽

Middle Eastern ◽

Bad News ◽

Breaking Bad News ◽

Chi Square ◽

Breaking Bad ◽

Health Related ◽

Chi Square Test ◽

Comparison Of Perspectives

9568 Background: It is believed in some Middle Eastern (ME) cultures that disclosure of bad news to cancer patients may cause loss of hope. On many occasions the relatives’ and patients’ wishes are opposed regarding this matter. This study investigates cancer patients’ and their relatives’ perspectives regarding communication of cancer-related bad news in a ME population. Methods: Nine close-ended questions were designed in a questionnaire format to obtain cancer patients’ (cohort I) and their relatives’ (cohort II) perspectives regarding communication of cancer related bad news from diagnosis to end-of-life. The questionnaire was answered by patients and relatives during out-patient visits. Chi-square test was used to test differences in responses between the two cohorts. Results: 203 participants (100 patients and 103 relatives) completed the questionnaire. In cohorts I and II, 28% and 58% of participants were males respectively (p<0.001). In contrast to relatives’ views, majority of patients preferred to be informed of diagnosis and possible adverse outcome of their illness, as detailed in the Table. Conclusions: Our study indicates that there is significant discordance between the preferences of ME cancer patients and their relatives regarding disclosure of cancer related bad news to the patient. As opposed to relatives’ beliefs, most patients would prefer to know bad news throughout the course of their illness. Unless a patient indicates otherwise, physicians should strive to keep cancer patients informed of their health related events. [Table: see text]

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Breaking bad news of cancer diagnosis – Perception of the cancer patients in a rural community in Malaysia

South Asian Journal of Cancer ◽

10.4103/2278-330x.130447 ◽

2014 ◽

Vol 03 (02) ◽

pp. 116-121 ◽

Cited By ~ 4

Author(s):

Mathew Gabriel Bain ◽

Cheah Whye Lian ◽

Chang Ching Thon

Keyword(s):

Cancer Patients ◽

Cancer Diagnosis ◽

Current Method ◽

Bad News ◽

Breaking Bad News ◽

Language Management ◽

Cross Sectional ◽

Breaking Bad ◽

Information Giving ◽

Significant Difference

Abstract Context: Breaking of bad news is an important component in the management of cancer patients. Aims: This study aimed to assess the perceptions of breaking bad news of cancer diagnosis. Settings and Design: It was a cross-sectional study using Breaking Bad News Assessment Schedule (BAS) questionnaire on cancer patients in Serian district. Materials and Methods: Using snowballing sampling method, a total of 134 patients were interviewed face-to-face after the consent was obtained from each of the respondents. Statistical Analysis Used: Data was entered and analyzed using SPSS version 19.0. Results: Majority were comfortable with the current method of breaking bad news. The main aspects found to be the areas of concern were the importance of the usage of body language, management of time and identifying patients′ key area of concerns. There were significant difference between sex and "information giving" (P = 0.028) and "general consideration" (P = 0.016) and also between "the age and setting the scene" (P = 0.042). Significant difference was also found between the types of cancer and "the setting of scene" (P = 0.018), "breaking bad news technique" (P = 0.010), "eliciting concerns" (P = 0.003) and "information giving" (P = 0.004). Conclusion: Good and effective communication skill of breaking bad news is vital in the management of cancer patients. As the incidence of new cases of cancer increase every year, breaking of bad news has become a pertinent to the medical professionals′ role. Specific aspects of communication skills based on local characteristics should be more emphasized in the formulation of training for doctors.

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Breaking Bad News for Terminal Cancer Patients in Korea

The Korean Journal of Hospice and Palliative Care ◽

10.14475/kjhpc.2011.13.4.209 ◽

2010 ◽

Vol 13 (4) ◽

pp. 209-215

Author(s):

Chang Gon Kim

Keyword(s):

Cancer Patients ◽

Bad News ◽

Terminal Cancer ◽

Breaking Bad News ◽

Breaking Bad ◽

Terminal Cancer Patients

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Duration of intervals in the care seeking pathway for lung cancer in Bangladesh: A journey from symptoms triggering consultation to receipt of treatment

PLoS ONE ◽

10.1371/journal.pone.0257301 ◽

2021 ◽

Vol 16 (9) ◽

pp. e0257301

Author(s):

Adnan Ansar ◽

Virginia Lewis ◽

Christine Faye McDonald ◽

Chaojie Liu ◽

Muhammad Aziz Rahman

Keyword(s):

Lung Cancer ◽

Cancer Patients ◽

Rural Areas ◽

Care Pathway ◽

Tertiary Care ◽

Healthcare Providers ◽

Care Seeking ◽

Healthcare Seeking ◽

Lung Cancer Patients ◽

Initial Care

Timeliness in seeking care is critical for lung cancer patients’ survival and better prognosis. The care seeking trajectory of patients with lung cancer in Bangladesh has not been explored, despite the differences in health systems and structures compared to high income countries. This study investigated the symptoms triggering healthcare seeking, preferred healthcare providers (including informal healthcare providers such as pharmacy retailers, village doctors, and “traditional healers”), and the duration of intervals in the lung cancer care pathway of patients in Bangladesh. A cross-sectional study was conducted in three tertiary care hospitals in Bangladesh among diagnosed lung cancer patients through face-to-face interview and medical record review. Time intervals from onset of symptom and care seeking events were calculated and compared between those who sought initial care from different providers using Wilcoxon rank sum tests. Among 418 study participants, the majority (90%) of whom were males, with a mean age of 57 ±9.86 years, cough and chest pain were the most common (23%) combination of symptoms triggering healthcare seeking. About two-thirds of the total respondents (60%) went to informal healthcare providers as their first point of contact. Living in rural areas, lower levels of education and lower income were associated with seeking care from such providers. The median duration between onset of symptom to confirmation of diagnosis was 121 days, between confirmation of diagnosis and initiation of treatment was 22 days, and between onset of symptom and initiation of treatment was 151 days. Pre-diagnosis durations were longer for those who had sought initial care from an informal provider (p<0.05). Time to first contact with a health provider was shorter in this study compared to other developed and developing countries but utilizing informal healthcare providers caused delays in diagnosis and initiation of treatment. Encouraging people to seek care from a formal healthcare provider may reduce the overall duration of the care seeking pathway.

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Breaking Bad News About Cancer: Patients’ Preferences for Communication

Journal of Clinical Oncology ◽

10.1200/jco.2001.19.7.2049 ◽

2001 ◽

Vol 19 (7) ◽

pp. 2049-2056 ◽

Cited By ~ 231

Author(s):

Patricia A. Parker ◽

Walter F. Baile ◽

Carl de Moor ◽

Renato Lenzi ◽

Andrzej P. Kudelka ◽

...

Keyword(s):

Cancer Patients ◽

Cancer Diagnosis ◽

Emotional Support ◽

Bad News ◽

Breaking Bad News ◽

Message Content ◽

Breaking Bad ◽

Physician Characteristics ◽

Context Variables ◽

Content Scale

PURPOSE: The goal of this study was to assess patients’ preferences regarding the way in which physicians deliver news about their cancer diagnosis and management. PATIENTS AND METHODS: A sample of 351 patients with a variety of cancers completed a measure assessing their preferences for how they would like to be told news about their cancer. Patients rated characteristics of the context and content of the conversation as well as physician characteristics. RESULTS: Factor analysis indicated that patients’ preferences for how they would like to be told news regarding their cancer can be grouped into the following three categories: (1) content (what and how much information is told); (2) facilitation (setting and context variables); and (3) support (emotional support during the interaction). Women (P = .02) and patients with higher education (P = .05) had significantly higher scores on the Content scale, women (P = .02) had higher scores on the Support scale, and younger patients (P = .001) and those with more education (P = .02) had higher scores on the Message Facilitation scale. Medical variables were not associated with patients’ ratings of the importance of the three subscales. CONCLUSION: Patients rated items addressing the message content as most important, though the supportive and facilitative dimensions were also rated highly. Understanding what is important to patients when told news about their cancer provides valuable information that may help refine how this challenging task is best performed.

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