TY - JOUR
T1 - Disclosure of cancer diagnosis and prognosis in Northern Tanzania
AU - Harris, Julian J.
AU - Shao, John
AU - Sugarman, Jeremy
N1 - Funding Information:
This research was funded in part by the Fogarty International Center, National Institutes of Health through the Minority International Research Training Program. Linda Lee Ph.D. helped with the study design. Research advice was provided in Tanzania by Gunther Lallinger, MD, MPH (Duke University) and Levina Msuya, MD (Tumaini University). Most importantly, the authors appreciate the willingness of the many health care providers to spend time sharing their thoughts regarding this important topic.
PY - 2003/3
Y1 - 2003/3
N2 - Whether to tell patients with cancer about their diagnoses and prognoses is a matter of great debate. While many argue the importance of giving this information to facilitate informed decision-making, others argue that this same information can extinguish hope. Although there is some evidence that disclosure of this information is now commonplace in many Northern and Western settings, there are very few data about this issue from resource-poor nations describing physicians' decision-making regarding whether to disclose this information. Using a combination of ethnographic and other qualitative methods including participant observation, semi-structured interviews, informal interviews, and a review of key documents in Northern Tanzania, we map some of the salient issues in this setting. Like their colleagues in many other parts of the world, Tanzanian physicians often withhold diagnostic and prognostic information from patients. In addition, however, to the cultural arguments often used to justify this practice, issues of treatment availability and patient poverty also influenced the physicians' disclosure practices. Expatriate and Tanzanian physicians practicing in Northern Tanzania often had different approaches to informing patients of their diagnoses and prognoses. Some Tanzanian physicians advocated the use of a "roundabout" approach to disclosure, arguing that it was more reflective of the normal mode of discourse in Tanzania than the more direct approach advocated by many of their expatriate colleagues. Expatriate physicians and some of their Tanzanian colleagues felt that such an indirect approach often left patients confused, or indeed, uninformed.
AB - Whether to tell patients with cancer about their diagnoses and prognoses is a matter of great debate. While many argue the importance of giving this information to facilitate informed decision-making, others argue that this same information can extinguish hope. Although there is some evidence that disclosure of this information is now commonplace in many Northern and Western settings, there are very few data about this issue from resource-poor nations describing physicians' decision-making regarding whether to disclose this information. Using a combination of ethnographic and other qualitative methods including participant observation, semi-structured interviews, informal interviews, and a review of key documents in Northern Tanzania, we map some of the salient issues in this setting. Like their colleagues in many other parts of the world, Tanzanian physicians often withhold diagnostic and prognostic information from patients. In addition, however, to the cultural arguments often used to justify this practice, issues of treatment availability and patient poverty also influenced the physicians' disclosure practices. Expatriate and Tanzanian physicians practicing in Northern Tanzania often had different approaches to informing patients of their diagnoses and prognoses. Some Tanzanian physicians advocated the use of a "roundabout" approach to disclosure, arguing that it was more reflective of the normal mode of discourse in Tanzania than the more direct approach advocated by many of their expatriate colleagues. Expatriate physicians and some of their Tanzanian colleagues felt that such an indirect approach often left patients confused, or indeed, uninformed.
KW - Cancer
KW - Disclosure
KW - Ethics
KW - Tanzania
KW - Traditional medicine
KW - Truth-telling
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U2 - 10.1016/S0277-9536(02)00090-4
DO - 10.1016/S0277-9536(02)00090-4
M3 - Article
C2 - 12593865
AN - SCOPUS:0037364926
SN - 0277-9536
VL - 56
SP - 905
EP - 913
JO - Social Science and Medicine
JF - Social Science and Medicine
IS - 5
ER -