Psychosocial Distress as a Factor in Patients With Cancer Seeking Support: A Hermeneutic Study

Cancer is one of the main causes of human death in the world, but its mortality rates have been in continual decline for the past 20 years (Siegel, Miller, & Jemal, 2015). It is a growing problem in Middle Eastern countries (Daher, 2011). In Iran, an ancient country in the Middle East (Borimnejad, Mardani-Hamooleh, Seyedfatemi, & Tahmasebi, 2014), cancer is the third most common cause of death, after heart disease and traffic accidents. The incidence of cancer in Iran is anticipated to be around 48 to 112 and 51 to 144 cases per year per million people for women and men, respectively (Seyedfatemi, Borimnejad, Mardani-Hamooleh, & Tahmasebi, 2014). As the incidence of new cases of cancer increases every year, breaking bad news to patients is very important. Bad news is described as any piece of information that could potentially be directed to negatively change a patient’s expectations, ideas, feelings, or outlook (Salem & Salem, 2013). Breaking bad news to patients with cancer is a delicate and challenging task for most health-care providers (Eng, Yaakup, Shah, Jaffar, & Omar, 2012). Bad news about cancer creates pain for patients (Zebrack, Chesler, & Kaplan, 2010). It is unexpected and often may come as a shock (Yoo, Levine, Aviv, Ewing, & Au, 2010). In this regard, despite efforts by family members to conceal cancer diagnoses from patients, the majority of patients discovered the diagnosis of their own accord (Wang, Guo, Peng, Su, & Chen, 2011). Breaking bad news to patients with cancer is diverse across different cultures (Table 1). Nondisclosure is the norm for Iranian people. However, health-care workers often want to tell patients of their diagnosis but worry that breaking bad news could evoke fear and anxiety for patients. In fact, it is difficult for health-care workers to predict cancer patients’ responses following disclosure. Therefore, a significant percent of cancer patients in many Mediterranean countries, such as Iran, are not made aware of their diagnosis, and many health-care workers prefer to disclose the cancer diagnosis directly to patients’ family members. However, the clinical experiences of the researchers show that family members rarely transfer this information to patients, and frequently prevent the disclosure of the cancer diagnosis.