Truth telling by healthcare providers to Terminally ill cancer patients at ocean road Hospital in Dar-es-salaam.

Abstract

Truth telling by healthcare providers to terminally ill cancer patients is not only an important aspect of patient care but also a medical fundamental right of a patient. Despite available evidence of significance of truth telling, and the recommendation by the General Medical Council as the statutory regulatory for the medical profession in the United Kingdom (UK) since 2009 and currently Tanzania National Healthy Research Forum, recommend that healthcare providers should give patients information they want or need in a way they can understand, its implementation is still low especially in developing countries. In Tanzania, little is known regarding the factors influencing implementation of the ethical standard of truth telling to cancer patients. This study aimed at examining the factors influencing truth telling by healthcare providers to terminally ill cancer patients at Ocean Road Cancer Institute in Dar-es-Salaam. The study employed exploratory case study research design using a qualitative approach of data collection to explore factors influencing the implementation of the bioethical standard of truth telling by healthcare providers to terminally ill cancer patients at Ocean Road Cancer Institute (ORCI) in Dar-es-Salaam. Cancer patients at a terminal stage and healthcare providers were purposively selected to participate in this study. Data was collected by using a well-structured set of interview guides to key informants with open ended questions and audio-recorder; they were Tran-scripted and translated. Thematic analytical approach was applied to arrive at categories through the process of coding and forming key themes. Data was collected between; early April up to early May 2018. Twenty-one (21) study participants were involved; of these 13 were healthcare providers and terminally ill cancer patients were 8. The implementation of ethical principle of truth telling to terminally ill cancer patients by healthcare providers at ORCI was less implemented than what ought to be. This was reported to be influenced by a number of factors; those stemming from healthcare providers include: lack of a comprehensive understanding of Healthcare providers, sympathetic feeling, limited time, doctor-patient‟s relationship, telling as both good and bad thing, lack of guidelines, lack of adequate facilities, number of patients and multi-disciplinary team. Those factors stemming from patients include; level of understanding, freedom of choice to information, rights to information, lack of prior information, psychological condition and faith and beliefs. And those factors stemming from socio-cultural include; traditional beliefs and cultural communication style and family collusion. There is a gap of truth telling to terminally ill cancer patients by healthcare providers at ORCI. Healthcare providers at ORCI should have ongoing trainings so as to be equipped with knowledge and communication skills about truth telling. The ORCI should have well stipulated guidelines on truth telling to terminally ill cancer patients as how, when, to whom and by whom. The guidelines should spell clearly the qualities of a multidisciplinary team which by all means should include experts‟ personnel like oncologists, nurses, psychiatrists, medical ethicists, psychologists and spiritual leaders.