Cultural Differences in Perceived Appropriateness of Breaking Bad News to Patients: A Direct Comparison of Togo and France

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"We examined cross-cultural differences in people’s positions regarding the appropriateness of breaking of bad news to elderly patients. A total of 450 Togolese and French people who had in the past received bad medical news were presented with 72 vignettes depicting communication of bad news to elderly female patients and asked to indicate the appropriateness of physicians’ conduct in each case. The vignettes comprised five pieces of information: (a) the severity of the disease, (b) the patient’s wishes, (c) the level of social support during hospitalization, (d) the patient’s psychological robustness, and (e) the physician’s decision about communicating bad news. Through cluster analysis, six qualitatively different positions were found: (a) Always Tell the Truth to Patients, (b) Tell the Truth to Patients or their Relatives, (c) Depends on Patients’ Wishes, (d) Tell the Truth to the Relatives, (e) Don’t Tell the Truth to Patients, and (f) Undetermined. The French participants reported a stronger tendency to endorse the view that physicians should always tell the truth directly to the patient than the Togolese participants. In contrast, there was a stronger tendency among the Togolese participants to endorse the view that physicians should inform the patient’s family first than among the French. These findings highlight the importance for physicians, at the time of delivering bad news, of considering patients’ cultural values and of tailoring their disclosure approaches to match the diversity of patients’ personal preferences."