Responding to family requests for nondisclosure: The impact of oncologists' cultural background

Nondisclosure of cancer diagnosis is common in many Eastern countries. Consequently, immigrant families often approach oncologists with requests for nondisclosure in Western countries. Aims: To explore differences in the attitudes and practices of Western‑born and nonWestern born oncologists in Australia when faced with a nondisclosure request

Primary family caregiversʼ reasons for disclosing versus not disclosing a cancer diagnosis in India

Background Nondisclosure of cancer diagnosis continues to be practiced in India, with many family caregivers concealing it from patients in order to protect them from emotional distress. Objective The aim of this study was to explore Indian primary family caregivers' reasons for, and experiences of, disclosure versus nondisclosure to patients about their cancer diagnosis. Methods Indian disclosing (n = 8) and nondisclosing (n = 7) primary family caregivers participated in semistructured interviews exploring their reasons for disclosure versus nondisclosure of cancer diagnosis to their patient. Qualitative content analysis was used to classify the reasons for and for not disclosing. Illustrative quotes were selected to highlight caregivers' motivations for, and experiences of, each reason. Results The findings revealed 6 main reasons for disclosing (emotional well-being, lack of control, preparing the patient, family reasons, patient's personality, and longevity/curability of the disease) and 6 reasons for not disclosing (emotional well-being, family reasons, patient's personality, longevity/curability of the disease, barriers to communication, and disease severity). Typically, disclosing caregivers considered reasons for as well as against disclosure, whereas nondisclosing caregivers considered reasons against disclosure. Conclusions Most of the reasons given for disclosing and not disclosing were the same, although these reasons operated differently for disclosing and nondisclosing caregivers. In addition, justification for these reasons demonstrated cognitive consistency effects that appeared to reduce any feelings of dissonance regarding caregivers' disclosure, or nondisclosure, decisions. Implications for Practice Cancer nurses should provide additional psychological support to nondisclosing caregivers, especially with regard to how they view and engage in their caregiving role

Sense of coherence and chronic illnesses: Scope for research in India

The theory of salutogenesis focusses on how individuals move in the direction of health rather than illness. Within this is the concept of sense of coherence (SOC) that refers to a stable disposition which creates coping resources and a sense of health preservation. With the help of a widely validated SOC scale, a range of studies evidenced that a strong SOC was associated with psychological well-being, healthy behaviors, and good health. Although the cross-cultural nature of SOC is supported, there is limited research exploring SOC in Asian cultures. Understanding how people orient themselves toward health and leveraging this in the development of health interventions within the unique cultural context of India is necessary. The current paper will review the theory of salutogensis and SOC concept, the measurement of SOC, the relationship between SOC, chronic illnesses, and culture, concluding with suggestions for possible areas of SOC research in Indi

Understanding coping with cancer: How can qualitative research help?

Research in psycho-oncology investigates the psycho-social and emotional aspects of cancer and how this is related to health, well-being and overall patient care. Coping with cancer is a prime focus for researchers owing to its impact on patients' psychological processing and life in general. Research so far has focused mainly on quantitative study designs such as questionnaires to examine the coping strategies used by cancer patients. However, in order to gain a rich and deep understanding of the reasons, processes and types of strategies that patients use to deal with cancer, qualitative study designs are necessary. Few studies have used qualitative designs such as semi-structured interviews to explore coping with cancer. The current paper aims to review the suitability and benefits of using qualitative research designs to understand coping with cancer with the help of some key literature in psycho-oncology research

Caregivers' and patients' experiences of (non)disclosure of a cancer diagnosis in India

Non-disclosure of a cancer diagnosis is a common practice in Asian cultures. However, little is known about the reasons for (non)disclosure among caregivers and the psychological experience of (non)disclosure on patients. This thesis reports four studies on cancer diagnosis (non)disclosure in India using the Common Sense Model of illness representations as a theoretical framework. Study 1 explored the experiences of, and reasons for, (non)disclosure among family caregivers of cancer patients using a qualitative methodology. Informing caregivers cited a range of reasons for informing including patient's suspicion, preparation, patient's personality, lack of control, patient's emotional well-being and self-belief. In contrast, non-informing caregivers cited patient's emotional well-being, patient's personality, jeopardizing patient's lifespan and family concerns as reasons for not informing. Study 2 examined differences between informing and non-informing caregivers on various demographic, medical and psychological variables. Reasons for, and for not, informing were the most important discriminating variables; informing caregivers more likely to agree with preparing the patient and patient's personality as reasons for informing, whereas noninforming caregivers more likely to agree with longevity and patient's personality as reasons for not informing. Study 3 explored the experiences of (non)disclosure in cancer patients using a qualitative methodology. Non-informed patients had an intense negative experience of the illness and used only passive coping strategies, whereas informed patients used a range of coping strategies. Study 4 investigated differences between informed and non-informed patients on various demographic, medical and psychological variables. Non-informed patients were less educated, were less likely to be involved in medical decision-making, were less likely to be having a combination of treatments, had weaker illness coherence, and were less likely to engage in a range of coping strategies. The thesis findings have important implications for both patient care and our understanding of the role of illness perceptions in caregivers and patients.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Responding to family requests for nondisclosure: The impact of oncologists′ cultural background

Context: Nondisclosure of cancer diagnosis is common in many Eastern countries. Consequently, immigrant families often approach oncologists with requests for nondisclosure in Western countries. Aims: To explore differences in the attitudes and practices of Western-born and nonWestern born oncologists in Australia when faced with a nondisclosure request. Settings and Design: Using a cross-sectional design, oncologists were interviewed over the telephone. Methods: Using the snowball method, 14 Australian (Western = 9, non-Western = 5) oncologists were recruited. Oncologists participated in a semi-structured interview exploring their experiences of, and response to, a request for nondisclosure, and their perceptions of how their cultural background influenced these attitudes and responses. Analysis: The interviews were transcribed and analyzed using interpretative phenomenological analysis. Results: Six main themes emerged from the study: (1) Barriers to truthful communication, (2) an ethical and moral dilemma, (3) high costs of nondisclosure, (4) cultural influences on interpretation and understanding of requests for nondisclosure, (5) emotional impact of bad news on patients, families and oncologists, and (6) truthful disclosure as a gentle balancing act. Conclusions: All oncologists felt that the family request for nondisclosure was difficult, with many cultural and emotional nuances to take into consideration. Some immigrant Australian oncologists who had a similar cultural background as the patient/family, felt they could better understand the desire for nondisclosure. Irrespective of their cultural background, all oncologists acknowledged that breaking bad news had to be done in a gentle, gradual manner. The study suggests a need to develop a culturally sensitive cancer communication model

Facilitators of and barriers to diabetes self-management: An exploratory study among South Indian patients with type 2 diabetes, their primary caregivers and physicians

Background: Diabetes is a chronic illness which involves everyday self- management of a physician-recommended diet, exercise, self-monitoring of blood glucose (SMBG), and medication. Research suggests that there are several facilitators and barriers when attempting to adhere to this regimen. Therefore, using a qualitative methodology, the current doctoral work aimed to explore South Indian patients', their primary caregivers', and physicians' experiences and perspectives of Type II diabetes self-management in order to understand what helps and does not help in adherence

End-of-life decision-making in India

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