Table 4 Findings relating to perspectives on communication

Findings concerning Turkish patients

(Aksoy, 2005) [28]

61% of general public and 89% of professionals wanted to know diagnosis, but 58% of general public and 71% of professionals preferred to hide it from relatives.

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(Atesci et al., 2004) [29]

55% of cancer patients were unaware of diagnosis, 45% were aware; 68% guessed it from treatment process; 15% had been fully informed.

More psychiatric disorder in patients aware of diagnosis. Physicians may be reluctant to reveal diagnosis and prognosis, as cancer is regarded as a death sentence.

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(Bagcivan et al., 2009) [30]

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Many patients did not want to talk about pain as they feared dependency on analgesics and did not want to upset relatives.

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(Balseven Odabasi and Ornek Buken, 2009) [31]

85% of patients found that if a patient is diagnosed with cancer he should be informed about diagnosis.

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68% of physicians argued they had to tell diagnosis first to patients before informing relatives.

(Betke, 2005) [33]

Turkish elderly preferred not to talk about cancer or any other negative diagnosis to very ill patient. They didn’t want to reveal diagnosis to an incurable patient and preferred doctors to tell truth only to relatives.

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(Bozcuk et al., 2002) [34]

44% of cancer patients not aware of diagnosis.

Predictors of good emotional functioning: gender (males were more often accompanied) and social functioning.

44% of cancer patients informed about diagnosis.

There was no significant difference between scores on quality of life (QLQ-C30) between patients who knew and patients who did not know diagnosis.

(Buken, 2003) [37]

63% of patients diagnosed with cancer not aware of diagnosis. Level of informing increased with chance of recovery and patients’ socio-economic and educational level. 52% of physicians were ‘protective’, preferred not to tell truth. Reasons for not informing: lack of legal foundation and control and difficulty of changing protective physicians’ attitude.

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(Cetingoz et al., 2002) [39]

75% of the general Turkish population had satisfactory knowledge of cancer, 13% thought cancer is contagious, 87% thought cancer is fatal, but 40% also believed that half of all cancers can be cured.

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84% wanted to be informed of cancer diagnosis, but only 63% wanted relatives to be informed.

Presence of cancer in a relative did not influence results.

(De Meyere, 2004) [47]

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Less educated patients sometimes got to false information and believed that cancer is contagious.

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(Demirsoy et al., 2008) [48]

16% of patients (mixed cancer and non-cancer patients) were not aware of diagnosis; 84% knew diagnosis, but 19% of these reported a different diagnosis than on chart.

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66% of patients wanted to be informed about diagnosis, 33% did not want this, 95% wanted to know effects of available treatments.

90% of nurses wanted to inform patients about diagnosis and prognosis, 75% reported that patients should be informed.

(Erer et al., 2008) [49]

87% of patients (more types of cancers, 38% breast cancer) agreed that patients had right to be informed about diagnosis.

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(Ersoy and Goz, 2001) [53]

76% of nurses would in case a breast cancer patient asked for her diagnosis, tell truth (some after consulting physician); 24% would prefer not to tell it.

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(Ersoy and Gundogmus, 2003) [54]

53% of physicians would reveal diagnosis to a HIV patient, 8% would tell family but not patient, 18% would tell it to patient and his family together.

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44% of physicians would tell patient his diagnosis of lung cancer, 19% would first investigate patients’ competence, 12% would ask consent of family, 16% would not tell patient, in order not to harm him.

(Groen-van de Ven and Smits, 2009) [55]

The Christian Turks in this study obviously cared for parents, encouraged by faith and by community. Professional care could only be accepted when a trustful relation with relatives had been created.

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(Ilkilic, 2008) [56]

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Language barriers impeded physicians in making joint decisions with Turkish patients. They often could not understand discussions of patients and interfering relatives.

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(Meric and Elcioglu, 2004) [64]

57% of nurses noted that patients were not informed about diagnosis and prognosis.

29% of nurses faced problems in communication about care for terminally ill patients, they had feelings of empathy and loss when people die, 7% saw no problems and 63% had problems with some ‘special’ patients.

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58% thought patients should not be informed about prognosis.

All nurses felt relatives should be informed, 66% wanted to inform when diagnosis is clear, 34% wanted to inform when problems arise.

(Oflaz et al., 2010) [67]

96% of nurses did not want to inform patient about his terminal status.

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60% did not think a person should be told his illness is incurable or terminal.

(Oksuzoglu et al., 2006) [68]

48% of relatives wanted patient to be informed; 39% thought diagnosis should not be disclosed, 13% was hesitant.

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87% wanted family to be informed, 80% of the 39% that did not want to inform patient, wanted only family to be informed.

89% thought treating doctor should be messenger.

(Ozcakir et al., 2008) [70]

Medical students found talking to patients important, patients should get permission to die at home. Students disagreed that incurably ill patients should be told diagnosis.

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(Ozdogan et al., 2004) [71]

66% of relatives did not want patient to be informed about diagnosis; 57% because patient would be upset, 29% because patient would not want to know it.

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(Ozdogan et al., 2006) [72]

The percentages that never, rarely, generally, and always told truth about diagnosis were 9%, 39%, 45% and 7%.

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54% of physicians felt influenced by requests from relatives, 46% not. Physicians who felt influenced told truth less often than those who did not. Training in breaking bad news resulted in higher scores of telling truth.

(Pelin and Arda, 2000) [74]

93% of physicians thought patients should be informed about diagnosis, but one should avoid talking about life expectancy. 30% said they may choose to inform relatives.

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Older and more experienced physicians gave more information.

(Van den Bosch, 2010) [77]

Many Turkish patients generally trusted medical competence of GP, but communication was limited as Turkish elderly did not accept idea of incurability and felt discriminated or not being taken seriously. Some thought GP was not informing them fully.

Many Turkish patients did not want to talk about psychological problems.

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(Yerden, 2000) [80]

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Communication within family about future needs and solutions was limited.

Findings regarding Moroccan patients

(Errihani et al., 2005) [52]

33% of patients (diagnosed with cancer) were not aware of diagnosis and prognosis.

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In 89% of cases relatives were informed, in 9% only some very close kin, in 2% of cases patients lived with their disease in full discretion.

1% of patients’ families thought that cancer is contagious.

(Errihani et al., 2006) [50]

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Illiteracy and insufficient knowledge of Arabic caused problems. 37% were illiterate and 25% spoke Berber only.

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(McCarthy et al., 2004) [63]

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Physicians and nurses believed that pain in children with cancer is rarely expressed in Morocco, which hampered assessment of pain. For some Moroccans pain was inevitable. Some feared morphine addiction.

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Findings regarding Turkish and Moroccan patients ( sometimes other immigrant patients as well)

(De Graaff and Francke, 2003a) [17]

Several Turkish and Moroccan relatives said diagnosis and prognosis given by GP was not understood.

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Important information came from relatives or members of community who worked in health sector.

Informing within community is hampered by fear of gossiping.

(De Graaff and Francke, 2009) [45]

GPs and nurses perceived a taboo on communication about diagnosis of terminal illnesses.

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GPs and nurses found it difficult to distinguish patients’ wishes apart from relatives’ wishes, especially when relatives were translating.

GPs and nurses didn’t recognize influence of local migrant community on decision making in care.

(De Graaff et al., 2010a) [18]

Communication about diagnosis

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In cases with language barriers Dutch professionals struggled with relatives who were acting as interpreter and as person in charge.

Relatives needed information about diseases and choices of treatments, they lacked role models in care for dying patients.

Dutch professionals wished to inform patient and to realize advanced care planning, while Turkish and Moroccan relatives wished to keep patients’ hope alive. Turkish and Moroccan patients disliked direct way in which Dutch care providers informed patients.

(Meulenkamp et al., 2010) [65]

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Many elderly depended on children for administration and financial management. Some were illiterate; others did not have enough mastery of Dutch language.

Many migrant elderly enjoy participating in activities, but they also fear gossiping of compatriots.

(Koppenol et al., 2006) [59]

Relatives impeded doctors in informing patient about cancer diagnosis, although breast cancer women were often informed, because of surgery decisions. Many patients were in need of information, they felt bad, wanted to know reasons for complaints.

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Some patients didn’t want other people to be informed about illness; they feared gossiping and social isolation.

(Korstanje, 2008) [60]

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Relatives didn’t contact professionals because of language problems. Nurses were not well-informed as they spoke with Dutch-speaking relatives, who were not primary carers.

Caring relatives often felt overburdened, but could not discuss it, since helping was obviously expected.

(Mostafa, 2009) [66]

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Most women (with breast cancer) felt GP did not listen, resulting in late diagnosis. Women wanted treatment for physical complaints, not for mental care.

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(NOOM, 2009) [23]

Patients and relatives disliked direct way Dutch care providers informed patients about diagnosis.

Many immigrants didn’t talk about mental problems, instead they mentioned headache, pain in back or belly. Alzheimer disease was not recognized.

Assessment of symptoms was hampered by language barriers, as patients lost knowledge of Dutch.

Parents and children created a dilemma: ideal of children taking care of parents prevented them from discussing openly and looking for real solutions.

(VPTZ, 2008b) [26]

First generation immigrants did not talk about life-threatening illnesses. They were not amused by Dutch doctors informing them about diagnosis with little respect for family relations. Second generation immigrants wanted to be informed.

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Relatives who cared for dying patients advised discussing illness and dying within Moroccan and Turkish communities.

(Yerden and Van Koutrike, 2007) [82]

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Elderly faced language barriers, so children did administration.

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