Development of culturally sensitive guidelines for disclosing bad news in palliative care: Ethiopia

Abstract

Background: Breaking bad news is a difficult task and on occasions, such news is withheld from the patient. This task of disclosing life-threatening illness and poor prognosis requires a full understanding and appreciation of contextual cultural issues. There is scarce evidence of the cultural preferences regarding disclosure of bad news when a patient is diagnosed with life threatening-illness in the Ethiopian context. This study aimed to explores the Ethiopian community cultural preferences on the disclosure of bad news when a family member is diagnosed with a life-threatening disease to develop guidelines for this eventuality. Methods: A qualitative research approach and purposive sampling method were applied. In-depth interviews and observation were employed to collect data from fifty-one participants. In all, twenty-five in-depth interviews and twenty-six observations were undertaken. Field notes were taken during field observations. The study participants were patients, healthcare professionals and community members. Data was transcribed verbatim and analysed by using ATLAS.ti 22. The guideline developed was sent to nine experts and community members for their feedback on its applicability and cultural sensitivity. Findings: Patients with life-threatening-illness disclosed that they prefer full but culturally ensitive medical information regarding their diagnosis of serious illness. Disclosure of poor prognosis should preferably be delivered to the patient family. The religious beliefs, values and rituals of Ethiopian culture are important during the disclosure of news on life-threatening. The respondents identified some advantages of breaking disclosing bad news. Participants submitted that such news should be incremental rather than stunning, amiable, roundabout, sensitive and sympathetic. A six-step, culturally adaptive guideline for breaking negative news was developed and validated. Conclusion: Patients with life threatening-illness should be informed of their medical condition in the presence of family. Disclosure of bad news in such circumstances was perceived as helpful in curtailing expenses and meeting the patients’ needs in palliative care. The patients submitted on their participation in decision on treatments. Cultural values, religious beliefs and preferred approaches should be considered carefully when conveying bad news. The availability of culturally adaptive guidelines could assist healthcare professionals to accommodate the patients’ values, beliefs and preferences when disclosing bad news.