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Journal of Cancer Education, 24:180185, 2009 Copyright AACE and EACEISSN: 0885-8195 print / 1543-0154 online DOI: 10.1080/08858190902876262
Overcoming Cultural Barriers to Giving Bad News: Feasibility of Training to Promote Truth-Telling to Cancer Patients
ANNA COSTANTINI, PHD, WALTER F. BAILE, MD, RENATO LENZI, MD, MASSIMO COSTANTINI, MD, VINCENZO ZIPARO, MD,
PAOLO MARCHETTI, MD, LUIGI GRASSI, MD
AbstractBackground. In many countries, physicians are reluctant to disclose unfavorable medical information to patients with advanced cancer and instead give the bad news to the family. Methods. The authors modified standard communication workshops to help Italian senior oncologists overcome cultural, social, and attitudinal barriers to disclosure of diagnosis and prognosis. Results. Fifty-seven physicians participated; 88% believed the workshops would improve their medical practice. Many pursued further training and organized communication skills programs of their own. Conclusions. Communication skills workshops can be modified to meet educational and social norms and help clinicians acquire the interpersonal skills needed for honest communication with patients.
T he doctor had just finished rounds and was heading back to the office. An obviously agitated young woman approached and said, Doctor, you know my husband has an appointment with you this afternoon to discuss his test results. I want you to know that if his cancer has come back he cant know. If its bad news tell me, not him. Do you understand? He cant know.
DEFINING THE PROBLEM
In many countries outside of North America, withholding bad news from patients with cancer is common,1,2
despite indications that most cancer patients desire complete information about their illness and that such information has a positive effect on coping.3 To address this issue, some European countries such as Italy have established codes of medical ethics and laws governing informed consent for treatment4 to formalize physicians responsibilities in meeting patients expectations for and right to information. Thus, since 1998, Italian physicians have been bound to disclose disease information to patients and to respect their privacy regarding disclosure of information to others.
In Italy, however, as in a number of other countries, truth-telling about cancer is often influenced by culture-bound attitudes, religious values, and medical traditions.5 Often the intent of legal directives and patient desires are not met. To highlight this point, Costantini and colleagues6 interviewed over 1200 Italian caregivers...