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A Hermeneutic Interpretation of Nurses’ Experiences of Truth Telling and Harms in Cancer Care in Qatar

Alsaadi, Wafa A., MSN, BSN, RN; Rankin, Janet M., PhD, RN; Bylund, Carma L., PhD

doi: 10.1097/NCC.0000000000000663
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Background Telling the truth to cancer patients remains under debate in the Middle East, where concealment about diagnosis and prognosis occurs in some cases. Concealment results in challenges for nurses providing care.

Objective The aim of this study was to understand nurses’ lived experiences of caring for cancer patients whose cancer diagnosis or prognosis has been withheld from them.

Methods Eight nurses from the national cancer center in Qatar were interviewed. The transcripts of the interview texts were interpreted using Gadamer’s hermeneutic approach.

Results The interpretations are shaped by understandings of harm. Nurses assessed harm using empathy. Nurses’ empathy was permeated with fears that accompany a cancer diagnosis; the language of cancer is interpreted as a language of fear. It is ideas about harms and evoking patients’ fear that generates nurses’ experiences of complexity, ambiguity, and conflicting feelings regarding truth telling and concealment. The meanings nurses drew from their experiences rested on understandings about love, vulnerability, and opportunities to atone. We interpret nurses’ descriptions of being enmeshed in a web of lies through which multidimensional harms are experienced. The complexities of nurses’ experiences go well beyond the universal concepts of informed consent and patients’ rights.

Conclusions Nurses’ experiences reveal insights that likely resonate across other jurisdictions in the Arabic Gulf and other Eastern cultures, where nurses deal with these sensitive issues case by case.

Implications for Practice Leaders and health professionals in cancer care in such cultures must establish more nuanced and transparent interdisciplinary approaches to respond to the complexities of truth telling in cancer care.

Author Affiliations: Department of Nursing, Hamad Medical Corporation, Doha, Qatar (Mrs Alsaadi); University of Calgary, Alberta, Canada (Dr Rankin); Medial Education Department, Hamad Medical Corporation, Doha, Qatar (Dr Bylund); and Weill Cornell Medical College, New York (Dr Bylund).

The authors have no funding or conflicts of interest to disclose.

Correspondence: Wafa A. Alsaadi, MSN, BSN, RN, Department of Nursing, Hamad Medical Corporation, PO Box 3050, Doha, Qatar (walsaadi1@hamad.qa; walsaadi1@outlook.com).

Accepted for publication August 22, 2018.

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