Factors influencing truth telling by health care providers to terminally ill cancer patients at Ocean Road cancer institute in Dar es salaam, Tanzania.

Abstract

Background: Widely accepted international clinical ethics standards and Tanzania's national cancer treatment guidelines mandate that healthcare providers give patients the information they want or need in an understandable way. However, adherence to these standards is low, particularly in developing countries. In Tanzania, little is known regarding the views and practice of disclosure of diagnosis and prognosis to cancer patients. Objective: To examine the factors influencing truth-telling by healthcare providers to terminally ill cancer patients at Ocean Road Cancer Institute (ORCI) in Dar-es-Salaam, Tanzania. Methods: We conducted semi-structured interviews with a purposive sample of healthcare providers (n=13) and terminally ill cancer patients (n=8) in English and Swahili. The interviews were recorded, transcribed verbatim and translated into English. Results: The study findings show an unsatisfactory experience of truth-telling according to international clinical standards. Many healthcare providers emphasised barriers including: limited communication skills; limited time; a high volume of patients; and lack of privacy for communication. Patients' preferences and readiness to receive and accept information, as well as family collusion, were identified as barriers, whereas communalism was identified as a facilitator to truth-telling. Conclusion: We identified several barriers and facilitators of truth-telling that may be targeted in order to promote high-quality communication at ORCI. Our results support advocacy for improvements such as: training for clinical communication skills and information sharing; space designated to enhance privacy; deliberate efforts to employ enough providers to care for the increasing volume of patients; and need for counselling session with patients and family members prior to clinical information disclosure.