Oral Presentation COSA-IPOS Joint Scientific Meeting 2012

Understanding families’ requests for cancer nondisclosure: A qualitative study with Western and non-Western born oncologists (#248)

Mahati Chittem 1 , Phyllis Butow 2
  1. Indian Institute of Technology Hyderabad, Yeddumailaram, AP, India
  2. School of Psychology, University of Sydney, Sydney, NSW, Australia

Aims: Nondisclosure of a cancer diagnosis is commonly practiced in many collectivist countries. Although full disclosure of cancer diagnosis is the norm in Western countries like Australia, oncologists are still faced with requests for nondisclosure coming from patients’ families. While the law requires disclosure, the way that the request for nondisclosure is interpreted and dealt with varies. This study aimed to explore these differences using the cultural backdrop of Western and non-Western born oncologists. Methods: Using the snowball method, 14 Australian (Western = 9, non-Western = 5) oncologists were recruited. Oncologists participated in telephone semi-structured interviews exploring their experiences of a request for nondisclosure, how their cultural background influenced their attitudes, and how they handled the issue of nondisclosure. The interviews were transcribed and analysed using Interpretative Phenomenological Analysis. Results: Data saturation was reached at 8 interviews, although all 14 were analysed. Seven main themes emerged from the study: (i) barriers to truthful communication, (ii) nondisclosure requests pose an ethical/moral dilemma, (iii) high costs of nondisclosure, (iv) culture influences interpretation and understanding of nondisclosure, (v) truthful disclosure a gentle balancing act between families’ response and patients’ reactions, (vi) attitudinal shift over time in families, and (vii) emotional impact of bad news on both patients and oncologists. Conclusions: All oncologists felt that the family request for nondisclosure was a difficult one, with many cultural and emotional nuances to take into consideration. Due to the virtue of having a similar cultural background as the patient/family, some immigrant Australian oncologists could better understand the desire for nondisclosure. Interestingly, most oncologists adhered to their training in Western ethics rather than following the cultural norms of their home country. Finally, irrespective of the cultural background, all oncologists acknowledged that disclosure of cancer diagnosis had to be done in a gentle, gradual manner.