Ethical perspectives in communication in cancer care: An interpretative phenomenological study

Abstract

Background: In cancer care, many clinical contexts still lack a good-quality patient–health professional communication about diagnosis and prognosis. Information transmission enables patients to make informed choices about their own healthcare. Nevertheless, disclosure is still an ethically challenging clinical problem in cancer care. High-quality care can be achieved by understanding the perspectives of others. The perspective of patients, their caregivers, physicians and nurses have seldom been simultaneously studied. Objective: To investigate the phenomenon of diagnosis and prognosis-related communication as experienced by patients, their caregivers, and both their attending nurses and physicians, to enlighten meanings attached to communication by the four parties. Methods: A qualitative study using interpretative phenomenological analysis was performed. Participants and research context: Purposive sampling of six patients, six caregivers, seven nurses and five physicians was performed in two oncological hospitals in Italy. Ethical considerations: Local Ethics Committee approved the study. It was guided by the ethical principles of voluntary enrolment, anonymity, privacy and confidentiality. Results: Three main themes were identified: (a) the infinite range of possibilities in knowing and willing to know, (b) communication with the patient as a conflicting situation and (c) the bind of implicit and explicit meaning of communication. Conclusion: The interplay of meanings attached by patients, their caregivers, and their attending oncologist and nurse to communication about diagnosis and prognosis revealed complexities and ambiguities not yet settled. Physicians still need to solve the ethical tensions in their caring relationship with patients to really allow them ‘to choose with dignity and being aware of it’. Nurses need to develop awareness about their role in diagnosis and prognosis-related communication. This cognizance is essential not just to assure consistency of communication within the multi-disciplinary team but mostly because it allows and enables the moral agent to take its own responsibilities and be accountable for them.

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“…Data analysis was supported by the MAXQDA ® 2018 software as an instrumental part of the analysis strategy. To accomplish transparency, the researchers discussed the study’s challenges and difficulties [ 27 ]. All interviews were audio recorded and transcribed verbatim.…”

“…Ethical principles, such as duties, rights, and responsibilities, must be respected by health professionals, who must also be conscious of integrity, honesty, and justice [ 26 ] to create an ethical environment. Active listening can also be incorporated as it is essential for supportive attention to patients’ needs [ 27 ].…”

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“…Step 4: Searching for connections across emergent themes This step involves finding the connections across the emergent themes within the case (Melis et al, 2020). The analyst may transfer emergent themes into a separate document and cluster them with associated themes (Jeong and Othman, 2016;Rajasinghe, 2018).…”

“…However, it is important that the analyst continues to reflect on the importance of 'I' and 'P' in IPA (see Smith et al, 2009). Melis et al, (2020); for example, to emphasise the importance of ensuring idiographic commitments and how such initiatives facilitate substantial space for researchers to deepen participants' life world by allowing the phenomenon to shine forth through interpretative engagement.…”