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

Abstract

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.

Palliative care and quality of life needs and outcomes for Māori with cancer: what do we know?

“…Key informants suggested an additional 12 articles and 2 reports to the list, leaving 67 documents for full-text review. Following full-text review, 47 texts were excluded, leaving a remaining 18 articles and 2 book chapters for inclusion in the final review (Ahuriri-Driscoll et al, 2014; Angelo & Wilson, 2014; Cassim et al, 2021; Eldridge, 2014; Frey et al, 2013; Gott et al, 2015, 2018; Lawrenson et al, 2013; Mason, 2018; Ministry of Health, 2014; Moeke-Maxwell, 2014; Moeke-Maxwell et al, 2014, 2020; Moeke-Maxwell, Mason, Toohey, & Dudley, 2019; Moeke-Maxwell, Mason, Toohey, et al, 2019; Nelson-Becker & Moeke-Maxwell, 2020; Oetzel et al, 2015; Rauawaawa Kaumātua Charitable Trust, 2013; Slater et al, 2013, 2015, 2016; Wiles et al, 2018). Supplementary Table 1 provides a brief overview of the included studies.…”

“…Other 15 papers included Māori participants and considered palliative care, although not specific to cancer (Ahuriri-Driscoll et al, 2014; Eldridge, 2014; Gott et al, 2015, 2018; Lawrenson et al, 2013; Mason, 2018; Moeke-Maxwell, 2014; Moeke-Maxwell et al, 2020; Moeke-Maxwell, Mason, Toohey, & Dudley, 2019; Moeke-Maxwell, Mason, Toohey, et al, 2019; Nelson-Becker & Moeke-Maxwell, 2020; Oetzel et al, 2015; Rauawaawa Kaumātua Charitable Trust, 2013; Slater et al, 2016; Wiles et al, 2018). Of the remaining four articles, one considered palliative care and cancer not specifically for Māori (Frey et al, 2013), and the other three included Māori with cancer, not specifically in the palliative care setting (Angelo & Wilson, 2014; Cassim et al, 2021; Slater et al, 2013). All but two papers (Lawrenson et al, 2013; Slater et al, 2016) used a qualitative approach or descriptive analysis, and there were varying levels of focus on the aspects of quality of life.…”

“…The options are necessary for determining where and when care is provided, but also to determine what aspects of health care are important during the end stages of life, for example, spiritual and physical, and who is able to provide this care (Mason, 2018; Moeke-Maxwell, Mason, Toohey, et al, 2019; Nelson-Becker & Moeke-Maxwell, 2020; Oetzel et al, 2015; Slater et al, 2016). Communication is an ongoing process vital to understanding a diagnosis and the broader process around death and dying (Cassim et al, 2021; Slater et al, 2016). Cassim et al (2021) discuss this in the cancer setting, and although not palliative-care specific, the authors identify three key themes to this communication: the provision of a range of options and advice; positive discussion; and the use of clear language.…”

“…Communication is an ongoing process vital to understanding a diagnosis and the broader process around death and dying (Cassim et al, 2021; Slater et al, 2016). Cassim et al (2021) discuss this in the cancer setting, and although not palliative-care specific, the authors identify three key themes to this communication: the provision of a range of options and advice; positive discussion; and the use of clear language. Palliative care and cancer-specific resources, regardless of format, content and style need targeted provision to be specific for Māori (Frey et al, 2013; Mason, 2018; Rauawaawa Kaumātua Charitable Trust, 2013).…”

Physicians’ Skills in Breaking Bad News to Patients With Cancer Using SPIKES Protocol

“…reaking bad news (BBN), which is defined as "any news that negatively affect patients' view of future" is an unpleasant and challenging task for physicians , regardless of their [1,2].…”