Exploring communication in the care for children with cancer in Palestine: an ethnographic qualitative case study approach

Abstract

BackgroundThere has been little research in the Middle East regarding communication in the care for children with cancer. Findings of studies undertaken in diverse cultural settings show that health-care providers report being poorly prepared to communicate with children with cancer and feel inadequately prepared to support families facing loss. The Arab culture differs in numerous ways from western culture (eg, with regard to disclosing prognosis information to children). Therefore, this study explores the experiences of children, families, and health professionals in communication in the care of children with cancer in Palestine. MethodsThis study used an ethnographic qualitative case study approach. It was conducted in one oncology unit based in the West Bank. Two data collection methods were employed: participant observation and semi-structured interviews. Ethics approval was obtained from the hospital ethical review board. Informed written consent was obtained from all participants (or legal guardians, in the case of children). Findings70 hours of observation were undertaken and 35 interviews were conducted, involving five physicians, 11 nurses, six children aged 6–18 years, seven mothers, and six grandmothers. Although a few parents completely hid the diagnosis of leukaemia from their children, others tried to relieve the situation by informing their children of different diagnoses, such as a blood infection. The term cancer was avoided in the discussion of the disease by health-care providers and parents to ameliorate the negative effect of this term. The observational data showed that the children were not involved in discussions relating to their disease, and most communication about their illness was between their parents and physicians. InterpretationThe findings reveal the challenges that physicians, nurses, grandmothers, and mothers face in communicating with children with cancer. Each group reported a need to improve their communication skills with children with cancer. Strategies are needed to involve children in communication regarding their disease and their prognosis. FundingNone.