Department of Applied Information Technology, University of Gothenburg, Gothenburg, Sweden.
Department of Surgery, School of Medicine, Health Science College, Addis Ababa University, Addis Ababa, Sweden.
PLoS One. 2020 Mar 13;15(3):e0230309. doi: 10.1371/journal.pone.0230309. eCollection 2020.
Cancer is a growing concern in Ethiopia. Though communication is essential for the treatment process, few studies have looked at communication in Ethiopian cancer care. Due to the large number of patients and scarcity of resources, it is vital to understand how to manage consultations in order to effectively help as many patients as possible in this challenging work environment. Thus, research is needed to analyze and understand the communicative challenges experienced by physicians, patients, and family caregivers, in order to successfully handle patient care in practice.
We explore communication in Ethiopian cancer care and present the main challenges faced by physicians, patients, and family caregivers.
This explorative qualitative study was conducted at the Oncology Department of the Tikur Anbessa (Black Lion) Specialized Teaching Hospital (TASH) in Addis Ababa, Ethiopia. A triangulation of data collection methods was used: 91 audio-recorded, semi-structured interviews and 21 video-recordings of authentic interactions during hospital rounds. The aim was to obtain as complete a picture as possible of communication from the perspectives of physicians, patients, and family caregivers. The interviews were analyzed using thematic content analysis and the identified themes were supported by excerpts from the transcribed recordings.
Eight themes emerged from the data. Workload and time pressure, in combination with restricted space for privacy, limited the possibilities for physicians to deliver detailed information and provide emotional support. Furthermore, patient literacy levels, in combination with no or little cancer awareness, financial problems, reliance on traditional and religious treatments, the stigma of cancer, and a fatalistic attitude, resulted in delays in patients seeking care and participating in positive health behaviors, and, subsequently, often resulted in an unwillingness to openly discuss problems with physicians and adhere to treatment. The study also illustrates the paramount role of family in physician-patient communication in Ethiopia. Though family caregivers provide a valuable interpreting support when patients have limited language skills, they can also prevent patients from sharing information with physicians. Another important finding is that family caregivers were often responsible for making decisions about treatment and avoided telling patients about a poor prognosis, believing that conveying bad news may upset them. All of these themes have important implications for the role of ethically acceptable communication in patient-centered care.
This study has identified a number of serious challenges for successful and ethically acceptable health communication in Ethiopian cancer care. The study contributes to our understanding of the complexity around the role of family, combined with patients' dependency on family members for communication, support, and access to care, which creates particular ethical dilemmas for the medical staff. The questions raised by this study concern how to organize consultations to achieve patient-centered health communication, while maintaining a constructive alliance with the family and not jeopardizing the patient's continued access to care. The integration of communication training for medical students in Ethiopia, with a focus on ethical guidelines for family-centered patient consultation suitable for these circumstances, would be an essential step.
癌症是埃塞俄比亚日益关注的问题。尽管沟通对于治疗过程至关重要，但很少有研究关注埃塞俄比亚癌症护理中的沟通。由于患者数量众多且资源匮乏，了解如何管理咨询对于在这种具有挑战性的工作环境中有效地帮助尽可能多的患者至关重要。因此，需要研究来分析和理解医生、患者和家属在照顾患者时遇到的沟通挑战，以便在实践中成功处理患者护理。
我们探讨了埃塞俄比亚癌症护理中的沟通，并介绍了医生、患者和家属面临的主要挑战。
本探索性定性研究在埃塞俄比亚亚的斯亚贝巴提克里安巴萨（黑狮）专科医院（TASH）的肿瘤科进行。采用了数据收集方法的三角测量：91 次音频记录的半结构化访谈和 21 次医院查房期间的真实互动视频记录。目的是从医生、患者和家属的角度尽可能全面地了解沟通情况。访谈使用主题内容分析进行分析，并通过转录记录中的摘录支持确定的主题。
从数据中出现了八个主题。工作量和时间压力，加上隐私空间有限，限制了医生提供详细信息和提供情感支持的可能性。此外，患者的读写能力水平，加上对癌症缺乏认识、经济问题、依赖传统和宗教治疗、癌症污名化以及宿命论态度，导致患者寻求护理和参与积极健康行为的时间延迟，最终往往导致他们不愿意与医生公开讨论问题并坚持治疗。该研究还说明了在埃塞俄比亚，家庭在医患沟通中起着至关重要的作用。虽然当患者语言能力有限时，家属可以提供有价值的口译支持，但他们也可以阻止患者与医生分享信息。另一个重要发现是，家属通常负责做出治疗决策，并避免告知患者预后不佳，因为他们认为传达坏消息可能会让患者感到不安。所有这些主题都对以患者为中心的护理中合乎道德的可接受沟通的作用产生了重要影响。
本研究确定了埃塞俄比亚癌症护理中成功和合乎道德的可接受健康沟通面临的一些严重挑战。该研究有助于我们理解家庭的复杂性，以及患者对家庭成员的沟通、支持和获得护理的依赖，这为医务人员带来了特殊的伦理困境。这项研究提出的问题涉及如何组织咨询以实现以患者为中心的健康沟通，同时与家庭保持建设性的联盟，并且不危及患者继续获得护理的机会。在埃塞俄比亚，将医学学生的沟通培训纳入其中，重点是针对这种情况的以家庭为中心的患者咨询的道德准则，将是至关重要的一步。
