Breaking bad news in a cross-language context: A qualitative study to develop a set of culturally and linguistically appropriate phrases and techniques with Zulu speaking cancer patients.

Abstract

Breaking bad news (BBN) in healthcare is common. Guidelines abound but little is documented in an African context. We wanted to describe Zulu speaking patients' BBN experience and assess their opinions of internationally recommended techniques. BBN techniques were highlighted from the literature using systematic review methods. Semi-structured focus group interviews with Zulu speaking cancer patients were conducted. Data were analysed using Framework Analysis. Language concordance was central - regardless of whether this necessitated a nurse acting as translator. While non-abandonment, empathy and maintenance of hope was valued by participants, an oft-expressed belief in positive outcomes accounted for mixed responses to phrases implying ambiguity. In contrast, "I wish" phrases were appreciated. Silence received mixed responses with a strong dislike for silence as a front for non-disclosure. Language-related concerns dictated the bulk of participants BBN perspectives. While cultural and linguistic differences exist, good communication skills, empathy and the maintenance of hope remain central. BBN in a language in which the patient is fluent, whether mediated or not, should be the standard of care. Cultural and linguistic variance must be born in mind and clinicians should become familiar with the preferences of the communities they serve.