Barriers to communicating a cancer diagnosis to patients in a low- to middle-income context
Mélissa Henry, Sharon Nichols, Jennie M. Hwang, Scott D. Nichols, Philip Odiyo, Maggie Watson, Ali Alias, Patricia A. Parker, David W. Kissane, Chioma Asuzu, David W. Lounsbury
Abstract
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.