Communicating about prognosis with regard to osteosarcoma in a South African cross-cultural clinical setting: strategies and challenges



prognosis, patient–provider communication, cancer, osteosarcoma, cross-cultural


Background: Effective prognostic communication with patients is a prerequisite for treatment decision-making, yet it is a difficult task to manage with confidence. This paper explores the strategies used and challenges faced when communicating about prognosis in a cross-cultural clinical setting.

Patients and methods: We used a qualitative exploratory descriptive contextual design and gathered data using focus group interviews with healthcare professionals. Twenty-three healthcare professionals participated in three focus groups. We analysed the data thematically. Guba’s Model of Trustworthiness was used to ensure rigour.

Results: Our findings revealed strategies for communicating about prognosis. Assessing patient emotions and knowledge, and providing patients with clear prognostic information, emerged as prominent strategies. Healthcare professionals proposed communicating frankly about the consequences of not treating osteosarcoma, treatment limitations, metastases and poor prognoses. They also suggested presenting prognostic information in a staged approach, normalising death, and not specifying life expectancy. In addition, informing patients that a palliative amputation would help with pain management emerged as a strategy for instilling hope. Various patient, provider and disease factors were identified as challenges when discussing prognosis.

Conclusions: Deviations from Western research findings emphasised the need for studies exploring prognostic communication in cross-cultural encounters. Our study highlighted the need for creative and thoughtful approaches to communicating sensitive information in cross-cultural clinical settings.

Level of evidence: Level 5

Author Biographies

O Brown, University of KwaZulu-Natal

PhD; Clinical Psychologist, School of Clinical Medicine, University of KwaZulu-Natal, South Africa

V Goliath, Nelson Mandela University

PhD; Associate Professor, Department of Social Development Professions, Nelson Mandela University, South Africa

R M Van Rooyen, Nelson Mandela University

MCur, PhD; Professor and Deputy Dean of the Faculty of Health Sciences, School of Clinical Care Sciences, Nelson Mandela University, South Africa

C Aldous, University of KwaZulu-Natal

PhD; Professor and Health Care Scientist in the School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa

L C Marais, University of KwaZulu-Natal

MBChB, FC(Orth)SA, MMed(Ortho), CIME, PhD; Professor and Head of the Department of Orthopaedics, University of KwaZulu-Natal, Durban, South Africa






Orthopaedic Oncology and Infections

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