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Indigenous perspectives on breaking bad news: ethical considerations for healthcare providers
  1. Shemana Cassim1,
  2. Jacquie Kidd2,
  3. Rawiri Keenan1,
  4. Karen Middleton3,
  5. Anna Rolleston4,
  6. Brendan Hokowhitu5,
  7. Melissa Firth1,
  8. Denise Aitken6,
  9. Janice Wong3,
  10. Ross Lawrenson1
  1. 1Waikato Medical Research Centre, Division of Arts, Law, Psychology and Social Sciences, University of Waikato, Hamilton, New Zealand
  2. 2School of Nursing, Auckland University of Technology, Auckland, New Zealand
  3. 3Respiratory Department, Waikato District Health Board, Hamilton, New Zealand
  4. 4The Centre for Health, Tauranga, New Zealand
  5. 5Te Pua Wananga ki te Ao Faculty of Māori and Indigenous Studies, University of Waikato, Hamilton, New Zealand
  6. 6Lakes District Health Board, Rotorua, New Zealand
  1. Correspondence to Dr Shemana Cassim, Waikato Medical Research Centre, Division of Arts, Law, Psychology and Social Sciences, University of Waikato, Hamilton 3216, New Zealand; shemana.cassim{at}waikato.ac.nz

Abstract

Most healthcare providers (HCPs) work from ethical principles based on a Western model of practice that may not adhere to the cultural values intrinsic to Indigenous peoples. Breaking bad news (BBN) is an important topic of ethical concern in health research. While much has been documented on BBN globally, the ethical implications of receiving bad news, from an Indigenous patient perspective in particular, is an area that requires further inquiry. This article discusses the experiences of Māori (Indigenous peoples of New Zealand) lung cancer patients and their families, in order to investigate the ethical implications of receiving bad news. Data collection occurred through 23 semistructured interviews and nine focus groups with Māori lung cancer patients and their families in four districts in the Midland Region of New Zealand: Waikato, Bay of Plenty, Lakes and Tairāwhiti. The findings of this study were categorised into two key themes: communication and context. Avenues for best practice include understanding the centrality of the HCP–patient relationship and family ties in the healthcare journey, and providing patients with the full range of viable treatment options including hope, clear advice and guidance when the situation calls for it. Overall, the findings of this study hold implications for providing culturally safe and humanistic cancer care when BBN to Māori and Indigenous patients.

  • public health ethics
  • health care for specific diseases/groups
  • minorities
  • quality of health care
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Footnotes

  • Twitter @DrRawiri

  • Contributors All authors have contributed significantly to this manuscript. SC: acquisition of data, interpretation of data, manuscript writing and revision. JK: original conception and design of study, acquisition of data, interpretation of data, manuscript writing and revision, RK: original conception and design of study, manuscript revision. KM: original conception and design of study, manuscript revision. AR: original conception and design of study, acquisition of data, manuscript revision. BH: original conception and design of study, manuscript revision. MF: original conception and design of study, manuscript revision. DA: original conception and design of study, manuscript revision. JW: original conception and design of study, manuscript revision. RL: original conception and design of study, manuscript writing and revision. All authors read and approved the final manuscript.

  • Funding This project was funded by the Health Research Council of New Zealand (HRC grant number 17/438, entitled ‘Improving early access to lung cancer diagnosis for Māori and Rural Communities’).

  • Disclaimer The funding body did not play a role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This project received ethical approval from the Health and Disabilities Ethics Committees (HDEC) of New Zealand – Ref 17/STH/158.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to this study are included in the article.

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