Barriers to communicating a cancer diagnosis to patients in a low- to middle-income context

Abstract

Objective. The aim of this study was to understand the needs and experiences of oncology professionals involved in communicating a diagnosis to adult and pediatric cancer patients in the low-middle income (LMI) context of Kenya, with a focus on identifying barriers and facilitators. Methods. A World Café focus group methodology was conducted and comprised 19 discussion groups of approximately 6 participants (n = 114 professionals). Thematic analysis was used to clarify barriers and facilitators of professional–patient communication. Results. Participants reported several obstacles that hinder communication between cancer patients and healthcare professionals in Kenya, including: patient-related barriers (ie, lack of terminology, health literacy), culture-related barriers (ie, cultural and religious beliefs about cancer, beliefs about children), and physician- and system-related barriers (ie, limited communication skills, organizational barriers). Communication facilitators included: the central role of family and cultural traditions, and the caring attitude of physicians when disclosing diagnosis and treatment procedures. Conclusions. The data indicate the potential need to adapt communication guidelines to the Kenyan context to disseminate skills training in a culturally relevant way. Also of importance may be to embed parallel public health strategies and health care structural changes to facilitate disclosure and mitigate any unintended negative effects such as stigma and social isolation.

Communication to adult patients undergoing cancer care by non-specialist nurses: a scoping review protocol

“…For example, a study in cancer care settings in Africa found that only 40% of nurses and 20% of physicians had formal communications training 23. Similar studies in Kenya and Belgium have also shown that lack of communication training is a major challenge in cancer care 24–26. In these studies, emphasis was placed on expanding and improving communication training during pre-service training, providing further guidance and mentorship during cancer care coordination and adapting communication to different contexts and/or cultural backgrounds.…”

Pediatric Early Warning Systems (PEWS) improve provider‐family communication from the provider perspective in pediatric cancer patients experiencing clinical deterioration

“…High‐quality communication between providers and patient families is an integral part of family‐centered pediatric care, 1 particularly during clinical deterioration. 2 There are, however, major barriers 3 , 4 , 5 to family‐centered communication, including family beliefs, health literacy, and provider‐family hierarchy. 6 In high‐income settings, these communication barriers are primarily related to institutional factors.…”

Communicating bad news to patients and families in African oncology settings

“…In Low‐and‐Middle Income Countries (LMICs), including many African countries—where access to quality cancer treatment is limited and where the majority of cancer patients present for treatment at a late stage—clinician‐patient communications involving the delivery of bad news, such as a confirmed diagnosis or poor prognosis, may be more often avoided, delayed, or truncated than in HIC settings 16–19 . And such communication tendencies may be especially likely in communities where specific sociocultural and religious beliefs denigrate or blame individuals for their disease, equate it with imminent suffering and death, or where cancer is feared to be a communicable and contagious disease 20–25 …”

“…[16][17][18][19] And such communication tendencies may be especially likely in communities where specific sociocultural and religious beliefs denigrate or blame individuals for their disease, equate it with imminent suffering and death, or where cancer is feared to be a communicable and contagious disease. [20][21][22][23][24][25] Furthermore, in LMICs where quality cancer care is out of reach to large segments of the population, due to either poor clinical infrastructure or prohibitive out-of-pocket expenses, or both, clinician-patient communication about delivering bad news may be compromised. 26,27 Such was the case in the United States in the 1950s through the 1970s, when cancer treatment outcomes were relatively bleak, and physicians considered it cruel and damaging to tell patients that they had cancer.…”