Breaking Bad News in Ethnic Settings: Perspectives of Patients and Families in Northern Sri Lanka

Abstract

PurposeThe discussion of a cancer diagnosis and prognosis often is difficult. This study explored the expectations of Tamil-speaking patients with cancer and their families with respect to receiving their cancer diagnosis in northern Sri Lanka.MethodsThis exploratory, descriptive, qualitative study used semistructured interviews.ResultsThematic analysis identified two major themes: communication and information seeking. The findings illustrate a discrepancy between patient preference for direct disclosure of the diagnosis and that of families. Ninety-five percent of patients wanted medical staff to disclose their cancer diagnosis, whereas only 45% of family members believed that the diagnosis should be disclosed to the patient rather than to the family.ConclusionAlthough patients and their family members’ views and expectations of the disclosure of diagnosis and prognosis differ, a majority of patients want to be told directly about their diagnosis rather than to learn of it from a relative. The findings are similar to the literature on other ethnic groups from Sri Lanka and studies from English-speaking developed countries. Therefore, the main questions are how to educate families and physicians about the benefits of open disclosure to patients and how to change culture. Results of this study along with a previous study call for the development of strategies and guidelines to improve societal views, educate patients and families, and train health professionals in the area of breaking bad news and discussing prognosis in the Sri Lankan setting.

Asian patients’ perspectives on advance care planning: A mixed-method systematic review and conceptual framework

“…Healthcare professionals' tendency toward partial disclosure or non-disclosure is not compatible with most Asian patients' reported preference for truth-telling communication. [61][62][63][64] Our study thus provides further confirmation of the fact that clarifying patients' understanding of their illness (including prognosis) by encouraging truthtelling communication is an important prerequisite for engagement in advance care planning.…”

Nurses' experiences and attitudes toward diagnosis disclosure for cancer patients in China: A qualitative study

“…Previous studies have demonstrated that there are many benefits of diagnosis disclosure for cancer patients . Despite the low diagnosis disclosure rate in Asian countries, many studies have found that a majority of patients with a terminal illness want to know the truth . Our former study also found that cancer patients' views of diagnosis disclosure were different from those of their family members.…”

“…[11][12][13] Despite the low diagnosis disclosure rate in Asian countries, many studies have found that a majority of patients with a terminal illness want to know the truth. [14][15][16] Our former study also found that cancer patients' views of diagnosis disclosure were different from those of their family members. Physicians in China should realize the different attitudes toward CDD between patients and family members.…”

Disclosure of cancer diagnosis in China: the incidence, patients’ situation, and different preferences between patients and their family members and related influence factors

“… 6 It is not the same thing in the non-Western countries. 7 , 8 Ruhnke et al’s study found that different from American patients, Japanese did not demand the cancer diagnosis be completely disclosed. 9 Patients in Saudi Arabia would prefer the family to be informed to assist them in taking treatment-related decisions.…”

“… 6 , 10 Rajasooriyar et al’s recent study found that in Sri Lanka, although patients and their family members’ views and expectations of the disclosure of diagnosis and prognosis differed, a majority of patients wanted to be told directly about their diagnosis rather than to learn of it from a relative. 8 Limited studies have been conducted on cancer patients’ preference for diagnosis disclosure in China. Thus, it is necessary to know the Chinese patients’ preference regarding diagnosis disclosure in order to provide recommendations that could be given to physicians.…”