Communicating bad news to patients and families in African oncology settings

Abstract

Aims:To assess clinicians' self-reported knowledge of current policies in African oncology settings, of their personal communication practices around sharing bad news with patients, and to identify barriers to the sharing of serious news in these settings. Methods:A cross-sectional study of cancer care providers in African oncology settings (N = 125) was conducted. Factor analysis was used to assess cross-cultural adaptation and uptake of an evidence-based protocol for disclosing bad news to patients with cancer and of providers' perceived barriers to disclosing bad news to patients with cancer. Analysis of Various (ANOVA) was used to assess strength of association with each dimension of these two measurement models by various categorical variables.Results: Providers from Nigeria, Kenya, Ghana, and Rwanda represented 85% of survey respondents. Two independent, psychometrically reliable, multi-dimensional measurement models were derived to assess providers' personal communication practices and providers' perceived barriers to disclosing a cancer diagnosis. Forty percent (40%) of respondent nurses but only 20% of respondent physicians had had formal communications skills training. Approximately 20%-25% of respondent physicians and nurses reported having a consistent plan or strategy for communicating bad news to their cancer patients. Conclusions: Results show that effective communication about cancer diagnosis and prognosis requires an appreciation and clinical skill set that blends an understanding of cancer-related internalized stigmas harbored by patient and family, dilemmas posed by treatment affordability, and the need to navigate family wishes about cancer-related diagnoses in the context of African oncology settings. Findings underscore the need for culturally grounded communications research and program design.

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][25][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.…”

“…However, even if communication training is in place, evidence suggests that trained healthcare providers need help with effective communication. 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.…”

Global psycho‐oncology in low middle‐income countries: Challenges and opportunities

“…However, the need for greater attention to interventional research in psychosocial oncology was highlighted by Onyeka et al 13 in a scoping review of the psychosocial aspects of cancer in sub-Saharan Africa. In a similar vein, based on a survey of cancer care providers in Africa, Lounsbury et al 23 provide support for the need for culturally grounded communication research and program design. To support this, Costa-Muniz et al 14 have provided a step-by-step guide to the cultural adaptation process for cancer-related interventions.…”

“…in a scoping review of the psychosocial aspects of cancer in sub‐Saharan Africa. In a similar vein, based on a survey of cancer care providers in Africa, Lounsbury et al 23 provide support for the need for culturally grounded communication research and program design. To support this, Costa‐Muniz et al 14 .…”