Nurses' Experiences and Perspectives on Breaking Bad News in Palliative Care Settings in Northern Ghana: A Multidisciplinary Study

Effective communication is critical in breaking bad news in a palliative care environment. Healthcare professionals in Northern Ghana practice in a multilingual and multicultural environment, but how the professionals, patients, and families experience communication has not been explored.This study explored communication strategies used by clinicians in breaking bad news in a palliative care setting in northern Ghana, and examines patients, families and healthcare professionals’ experiences, responses and preferences to bad news disclosure in palliative care. A qualitative phenomenology design was adopted. Seventeen participants, including five palliative care patients, five patient relatives, and seven healthcare providers were selected and interviewed through a purposive sampling technique. Data were collected through semi-structured interviews and analysed thematically using the Braun and Clarke’s approach.Findings revealed that clinicians adopted both structured communication (SPIKES) and adaptive approaches. Most patients preferred direct disclosure of bad news while family members preferred concealing information to protect patients. This situation creates an ethical dilemma for clinicians. Also, language restriction, family beliefs and cultural values influenced the disclosure of bad news.Participants relied on faith, family support, previous caregiving experience, clinicians’ clear communication, leisure activities and professional debriefing to cope with the emotional stress following the disclosure of bad news. The findings further suggest the practice of a social-autonomy model, where patient autonomy and family responsibility coexist.The disclosure of bad news in northern Ghana is influenced by language, cultural practices and family values. The study recommends culturally sensitive communication training and emotional support systems for healthcare professionals are recommended.