A qualitative study of the Omani physicians’ lived experience with truth disclosure to cancer patient

Ahmed Bait Amer, Nazik AL-Zakri

Behavioral Medicine, Sultan Qaboose University Hospital, Muscat, Oman.
[e-mail].

DOI: 10.4236/ojn.2013.31017                

Abstract

Objectives: The purpose of this phenomenological Qualitative Study is to gain an in depth understanding of the nature and meaning of the experiences of physicians in relation to truth disclosure and ethics of veracity when diagnosing cancer. Methods: A qualitative phenomenological study using semi-structured interviews was conducted at Sultan Qaboos university hospital (SQUH), l to explore the Omani Physicians’ lived experiences with truth disclosure in patients who were diagnosed with cancer. The target population for this study is Omani physicians working in SQUH. The total of four participants was involved in this study. Results: Three essential themes were generated through the analysis of the participants’ descriptions of their perceptions and lived experiences as the following with their subthemes: the first theme is the clinical aspect of the experiences with three subthemes: 1) The ethical aspect and the physician’s attitude; 2) The strategy of breaking bad news; 3) Training and breaking bad news. The second theme is Cultural diversity with three subthemes: 1) Relatives preference; 2) The patient education; 3) The hospital setting. The third theme is the emotional aspect of the experiences with five subthemes: 1) Emotional sadness; 2) Personal grief; 3) Other emotions; 4) The positive emotions; 5) Control of the emotions. Conclusion: This study recommends: to build up appropriate measures and guidelines on the subject of truth telling and medical ethics, and to provide more training for the health care providers in the context of breaking bad news. In addition to add to the curriculum of medical colleges the basic ethical principles relevant to medical practice. Finally, to establish medical social work departments in SQUH, and other healthcare institutions in Oman.

Keywords

Telling the Truth; Ethics; Cancer; Communication; Oman; Health Care Provider

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Surbone, A., Ritossa, C. and Spagnolo, A.G. (2004) Evolution of truth-telling attitudes and practices in Italy. Critical Reviews in Oncology/Hematology, 52, 165-172. doi:10.1016/j.critrevonc.2004.09.002
[2]	Farzaneh, Z. and Bagher, L. (2007) Cancer ethics from the Islamic point of view. Iranian Journal of Allergy, Asthma and Immunology, 6, 17-24.
[3]	Tatsuo, A., Tomohito, N., Hitoshi, O., Seiko, U., Nobuya, A., Tatsuro, N., et al. (2001) Psychiatric disorders in cancer patients: Descriptive analysis of 1721 psychiatric referrals at two Japanese cancer center hospitals. Japanese Journal of Clinical Oncology, 131, 188-194.
[4]	Alexander, P.J., Dinesh, N. and Vidayasagar, M.S. (1993) Psychiatric morbidity among cancer patients and its relationship with awareness of illness and expectations about treatment outcome. Acta Oncologica, 32, 623-626. doi:10.3109/02841869309092441
[5]	Atesci, F.C., Baltalarli, B., Oguzhanoglu, N.K., Karadag, F., Ozdel, O. and Karagoz, N. (2004) Psychiatric morbidity among cancer patients and awareness of illness. Supportive Care Cancer, 12, 161-167. doi:10.1007/s00520-003-0585-y
[6]	Buken, N.O. (2003) Truth telling information and communication with cancer patient in turkey. Journal of the International Society for the History of Islamic Medicine, 2, 31-37.
[7]	Beauchamp, T.L. and Childress, J.F. (2009) Principles of biomedical ethics. 6th Edition, Oxford University Press, New York.
[8]	Sokol, D.K. (2006) Truth-telling in the doctor-patient relationship: A case analysis. Clinical Ethics, 1,000-100.
[9]	Baider, L. and Surbone, A. (2010) Cancer and the family: The silent words of truth. Journal of Clinical Oncology, 28, 1269-1272. doi:10.1200/JCO.2009.25.1223
[10]	Hébert, P.C., Hoffmaster, B., Glass, K.C. and Singer, P.A. (1997) Truth telling. Bioethics for clinicians. Canadian Medical Association Journal, 156, 225-228.
[11]	Elkin, E.B., Kim, S.H., Casper, E.S., Kissane, D.W. and Schrag, D. (2007) Desire for information and involvement in treatment decisions: Elderly cancer patients’ preferences and their physicians’ perceptions. Journal of Clinical Oncology, 25, 5275-5280. doi:10.1200/JCO.2007.11.1922
[12]	Searight, H.R. and Gafford, J. (2005) Cultural diversity at the end of life: Issues and guidelines for family physicians. American Family Physician, 71, 515-522.
[13]	Gordon, M. and Marcia, S. (2005) Protection from the truth: A challenge for surrogates and health care professionals. Annals of Long-Term Care, 13, 10-11.
[14]	Al-Amri, A.M. (2009) Cancer patients’ desire for information: A study in a teaching hospital in Saudi Arabia. Eastern Mediterranean Health Journal, 15, 19-24.
[15]	Mobeireek, A.F., Al Kassimi, F., Al Zahrani, K., Al Shimemeri, A., Al Damegh, S., Al Amoudi, O., et al. (2008) Information disclosure and decision-making: The Middle East versus the Far East and the west. Journal of Medical Ethics, 34, 225-229. doi:10.1136/jme.2006.019638
[16]	Van Manen, M. (1990) Researching lived experience: Human science for an action sensitive pedagogy. State University of New York Press, Albany.
[17]	Blau, R., Bolus, S., Carolan, T., Kramer, D., Mahoney, E., Jette, D.U. and Beal, J.A. (2002) The experience of providing physical therapy in a changing health care environment. Physical Therapy, 82, 648-657.
[18]	Lane, M.R. (2005) Spirit body healing—A hermeneutic, phenomenological study examining the lived experience of art and healing. Cancer Nursing, 28, 285-291. doi:10.1097/00002820-200507000-00008
[19]	Wood, W.A., McCabe, M.S. and Goldberge, R.M. (2009) Commentary: Disclosure in oncology—To whom does the truth belong? The Oncologist, 14, 77-82. doi:10.1634/theoncologist.2008-0158
[20]	Soler, D. (2005) Telling patients the truth. Malta Medical Journal, 4, 56.
[21]	Drane, J.F. (2002) Honesty in medicine: Should doctors tell the truth? American Journal of Bioethics, 2, 14-17.
[22]	Kendall, S. (2006) Being asked not to tell: Nurses’ experiences of caring for cancer patients not told their diagnosis. Journal of Clinical Nursing, 15, 1149-1157. doi:10.1111/j.1365-2702.2006.01460.x
[23]	Meredith, C., Symonds, P., Webster, L., Lamont, D., Pyper, E., Gillis, C.R., et al. (1996) Information needs of cancer patients in west Scotland: Cross sectional survey of patients’ views. British Medical Journal, 313, 699-700. doi:10.1136/bmj.313.7059.724
[24]	Blazekovi?-Milakovi?, S., Matijasevi?, I., Stojanovi?-Spehar, S. and Supe, S. (2006) Family physicians views on disclosure of a diagnosis of cancer & care of terminally ill patients. Psychiatria Danubina, 18, 19-29.
[25]	Lee, A. and Wu, H.Y. (2002) Diagnosis disclosure in cancer patients—When the family says “no!”. Singapore Medical Association, 43, 533-538.
[26]	Asai, A. (1995) Should physicians tell patients the truth? The Western Journal of Medicine, 163, 36-39.
[27]	Tan, T.K.S., Teo, F.C.P., Wong, K. and Lim, H.L. (1993) Cancer: To tell or not to tell? Singapore Medical Journal, 34, 202-203.
[28]	Al-Qrni, M.M., Al-Sayis A. and Shaikh B.Z. (2007) Social work and patient with cancer. Daar Al-Rushid, ALRiyadh, 3, 27.
[29]	Gadalla, T.M. (2007) Cancer patients’ use of social work services in Canada: Prevalence, profile, and predictors of use. Health & Social Work, 32, 189-196. doi:10.1093/hsw/32.3.189
[30]	Gregorian, C. (2005) A career in hospital social work: Do you have what it takes? Social Work in Health Care, 40, 1-14. doi:10.1300/J010v40n03_01
[31]	Christ, G. and Blacker, S.E. Palliative care with older adults, section 2: Social work role in palliative care. Council on Social Work Education, National Center. http://www.cswe.org/File.aspx?id=24173