Communicating about prognosis with regard to osteosarcoma in a South African cross-cultural clinical setting: strategies and challenges

Abstract

Background: Effective prognostic communication with patients is a prerequisite for treatment decision-making, yet it is a difficult task to manage with confidence. This paper explores the strategies used and challenges faced when communicating about prognosis in a cross-cultural clinical setting. Patients and methods: We used a qualitative exploratory descriptive contextual design and gathered data using focus group interviews with healthcare professionals. Twenty-three healthcare professionals participated in three focus groups. We analysed the data thematically. Guba's Model of Trustworthiness was used to ensure rigour. Results: Our findings revealed strategies for communicating about prognosis. Assessing patient emotions and knowledge, and providing patients with clear prognostic information, emerged as prominent strategies. Healthcare professionals proposed communicating frankly about the consequences of not treating osteosarcoma, treatment limitations, metastases and poor prognoses. They also suggested presenting prognostic information in a staged approach, normalising death, and not specifying life expectancy. In addition, informing patients that a palliative amputation would help with pain management emerged as a strategy for instilling hope. Various patient, provider and disease factors were identified as challenges when discussing prognosis. Conclusions: Deviations from Western research findings emphasised the need for studies exploring prognostic communication in cross-cultural encounters. Our study highlighted the need for creative and thoughtful approaches to communicating sensitive information in cross-cultural clinical settings.

Modular prosthetic reconstruction for primary bone tumours of the distal tibia in ten patients

“…These usually preclude amputation, often with increased morbidity and mortality of the patient. 8 Brown et al described the challenges associated with cross-cultural communication in this regard, and highlighted the family-centred decision-making unit, which often refuses a limb ablation. 8 In these circumstances, an alternative treatment, potentially with higher oncological risks, needs to be considered to prevent morbidity and possible mortality that may result from rejection of medical treatment.…”

“…8 Brown et al described the challenges associated with cross-cultural communication in this regard, and highlighted the family-centred decision-making unit, which often refuses a limb ablation. 8 In these circumstances, an alternative treatment, potentially with higher oncological risks, needs to be considered to prevent morbidity and possible mortality that may result from rejection of medical treatment. We, therefore, propose that in South Africa, and many other countries across the African continent, an attempt at limb-sparing surgery and distal tibial replacement may be considered.…”