Disclosure of Cancer Diagnosis to Patients and their Relatives in Turkey: Views of Accompanying Persons and Influential Factors in Reaching those Views

The views of cancer patients of Turkish, Moroccan, Surinamese, and Dutch-Caribbean descent on diagnosis, treatment and prognosis: A systematic literature review

BACKGROUND

The number of international migrants is increasing worldwide. The four major non-western ethnic groups in the Netherlands are Turkish, Moroccan, Surinamese, and Dutch-Caribbean. This review examined the scientific literature on the views of cancer patients from these four ethnic groups on cancer diagnosis, treatment, and prognosis.

METHODS

A systematic literature review was conducted using the databases EMBASE, Medline Web of Science, and Cochrane Central Register. Studies with patients who were of Turkish, Moroccan, Surinamese, and Dutch-Caribbean descent were included. Both qualitative and quantitative studies were included, and thematic analysis was performed. The methodological quality was assessed using the Mixed Methods Appraisal Tool.

RESULTS

Thirteen studies were conducted in Turkey on Turkish cancer patients, while three were conducted in the Netherlands on Turkish and Moroccan cancer patients. Four themes emerged from the included studies: disclosure of diagnosis, communication, information provision, and decision-making. The majority of cancer patients in Turkey wanted information regarding their diagnosis and treatment. However, disclosure of a cancer diagnosis was rarely discussed with cancer patients in Turkey, whereas in the Netherlands it was provided directly. Family members in both the host and native countries had a strong influence on communication and decision-making. No literature on this topic for Surinamese or Dutch-Caribbean cancer patients was found.

CONCLUSION

Although major ethnic groups live in host countries, there is a lack of knowledge on optimal communication and information disclosure on cancer to patients and their families.

POLICY SUMMARY

Further research into the views of ethnic groups on how to communicate about cancer is essential to ensuring that every patient receives optimal care and treatment.

Determination of the factors contributing to depression and anxiety in advanced stage lung cancer patients

Background

The diagnosis of cancer and initiation of treatment disrupt physical, emotional, and socio-economical stability of the patients by reducing the quality of lives and ultimately leading to depression and anxiety. We aimed to observe the indicators for anxiety and depression among lung cancer (LC) patients by comparing with other cancer (OC) patients.

Methods

This study has been conducted between 2017 and 2019. Questionnaires were provided for both LC and OC patients.

Results

Two hundred and thirty patients with the ages varied between 18 and 86 (median: 64.0) were included in the study. A total of 115 patients (case group) were diagnosed as LC, and the remaining were with OC diagnosis (control). No difference was determined between the groups in means of median anxiety and depression scores. Patients who required assistance in hospital procedures, daily life activities, and self-care had higher depression and anxiety scores (p < 0.05) compared to those did not require assistance. Anxiety and depression scores in OC groups showed a remarkable difference according to performance status (p < 0.001). The depression score of the patients who stated that they did not know their social rights was remarkably higher than those of the patients who stated that they know their social rights. We found no relationship between depression and anxiety scores because of disease caused income loss and expense increase.

Conclusion

For LC patients, declaration of requirement for assistance and supportive care in daily life can be an important indication for anxiety and depression. Lung cancer patients, especially those informed by health care professionals and provided psychosocial support following the information, require a patient-specific professional management approach.

Cancer Diagnosis Disclosure in a Northern Italian Hospital Report on 312 Consecutive Cancer Patients

To evaluate cancer diagnosis disclosure in a cohort of cancer patients attending an outpatient oncology unit, a prospective observational study was performed. Three hundred twelve consecutive patients were accrued between January and June 2005. A questionnaire was given to each patient; the questions were very simple and related to demographics, residence, sex, educational background, employment status, time elapsed after diagnosis, treatment received, existence of relatives, and health insurance. All patients but one entered the study. There were 185 women and 127 men; 120 patients had breast cancer, 84 colorectal cancer, 34 lung cancer, 28 ovarian cancer, 34 gastric cancer, and 12 pancreatic cancer. Of the total 311 evaluable cancer patients, 171 (54.98%) were correctly informed; of the remaining 140 patients, 67 (21.54%) were not sure, and 73 (23.47%) thought their disease was not cancer. These data suggest that the majority of cancer patients attending our outpatient oncology unit are being correctly informed about their diagnosis. In our series the type of tumor had an important impact on diagnosis disclosure, while age and educational status did not.

Attitudes Toward Cancer and Cancer Patients in an Urban Iranian Population

BACKGROUND

Because of the significant incidence and mortality of cancer in Iran, a Comprehensive National Cancer Control Program for the prevention and early detection of cancer was launched in 2007. However, cancer awareness and screening rates in Iran did not improve. This study aimed to evaluate public attitudes toward cancer and cancer patients in Iran.

MATERIALS AND METHODS

We conducted a cross-sectional survey among 953 non-institutionalized individuals in Isfahan, Iran, from November 2014 to February 2015. We collected data on attitudes toward cancer in three domains (impossibility of recovery, cancer stereotypes, and discrimination), as well as questions on willingness to disclose a cancer diagnosis.

RESULTS

Among all participants, 33.9% agreed that it is very difficult to regain one's health after a cancer diagnosis, 17.4% felt uncomfortable with a cancer patient, and 26.9% said that they would avoid marrying people whose family members had cancer. While 88.9% of study participants said that cancer patients deserve to be protected in society, 53.3% and 48.4% of participants agreed that they would not disclose a cancer diagnosis to neighbors and coworkers, respectively.

CONCLUSION

Negative attitudes with respect to impossibility of recovery and discrimination toward cancer and cancer patients were common among urban Iranians. Most people would not disclose a cancer diagnosis to others in spite of advancements in cancer diagnosis and treatment, reflecting unfavorable attitudes toward cancer and cancer patients in society. Successful implementation of cancer awareness and prevention programs in Iran may require social changes based on adequate information on cancer and cancer patients.

IMPLICATIONS FOR PRACTICE

Public attitudes toward cancer and cancer patients are an important factor affecting cancer control programs as well as quality of life and recovery of cancer patients. The issue has not been studied in Iran and the surrounding countries in the Middle East. This is the first report presented on the subject. These findings can be used by health policy makers, health managers, and clinicians for better practice.

How should realism and hope be combined in physician–patient communication at the end of life? An online focus-group study among participants with and without a Muslim background

Objective:

Maintaining false hope may result in prolonged curative aggressive treatments until the very last stage of life. In this study, we sought to explore how people think that realistic and hopeful information should best be combined in physician–patient communications at the end of life.

Method:

During a period of 15 days, participants of five online focus groups (OFGs) could log in onto a closed discussion site and offer responses to several topics. A variety of people participated: patients, older people, relatives, and healthcare professionals with and without a Muslim background. Participants with a Muslim background constituted a separate group, because previous research indicated that they might have distinct views on good end-of-life care and communication. Transcripts were analyzed following the principles of thematic analysis.

Results:

Participants from all focus groups preferred that physicians provide realistic information in an empathic way, stating that the patient would never be left on his own and that withholding curative treatment was not equal to withholding care, explicitly asking how the patient could be helped during the time remaining, and involving other professionals in the care process and communications. As such, physicians could support patients' transition from “hope for a cure” to “hope for a good death.” Muslims specified the way they wished to receive realistic information: first from a relative, and not by using the term “incurable illness,” but rather by informing the patient that they had no remaining curative treatments available.

Significance of results:

Realism and hope are not necessarily mutually exclusive and can be combined when providing realistic information in a delicate and culturally sensitive way. This study provides suggestions on how physicians can do so. Communication skills training as well as anchoring knowledge of the diversity of cultural and religious views into physicians' education could improve end-of-life communication.

Breaking Bad News to Togolese Patients

The aim of this study was to map Togolese people's positions regarding the breaking of bad news to elderly patients. Two hundred eleven participants 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 acceptability of the physician's conduct in each case. The vignettes were all combinations of five factors: (a) the severity of the disease, (b) the patient's wishes about disclosure, (c) the level of social support during hospitalization, (d) the patient's psychological robustness, and (e) the physician's decision about how to communicate the bad news. Five qualitatively different positions were found. Two percent of the participants preferred that the physician always tell the full truth to both the patient and her relatives, 8% preferred that the truth be told depending on the physician's perception of the situation, 15% preferred that the physician tell the truth but understood that in some cases nondisclosure to the patient was not inappropriate, 33% preferred that the physician tell the full truth to the relatives but not as much information to the patient, and 42% preferred that the physician tell the full truth to the relatives only. These findings present a challenge to European physicians taking care of African patients living in Europe or working in African hospitals, and to African physicians trained in Europe and now working in their home countries. If these physicians respect the imperative of always telling the truth directly to their patients, their behavior may trigger anger and considerable misunderstanding among African patients and their families.

Cancer diagnosis disclosure preferences of family caregivers of cancer patients in Egypt

OBJECTIVE

Family caregivers (FCs) of cancer patients are frequently seen as a barrier to honest communication with patients in Egypt. This study was conducted to investigate the attitude of FCs of cancer patients toward cancer diagnosis disclosure (CDD) and its determinants.

METHODS

A structured interview was used to assess the preferences of 288 FCs regarding CDD.

RESULTS

According to the FCs, 85% of patients were aware of their diagnosis. The majority (81%) of FCs preferred CDD to patients. In case they developed cancer, 92% of FCs wanted to know their diagnosis and 88% wanted to inform their families. In a univariate analysis, factors associated with FCs' negative attitude toward CDD to patients were as follows: patient's lower level of education (P = .001), patient's rural residence (P < .001), hematological malignancies (P < .001), FC's belief that the patient is unaware of diagnosis (P < .001), FC's unwillingness to know his/her own cancer diagnosis (P < .001), and FC's unwillingness to inform his/her family about his/her cancer diagnosis (P < .001). Only 2 factors predicted independently the negative attitude of FCs toward CDD, the FC's belief that the patient is unaware of diagnosis (P < .001), and the FC's unwillingness to know his/her own cancer diagnosis (P = .049).

CONCLUSIONS

The results suggest that the majority of FCs of Egyptian cancer patients prefer CDD to patients. The finding that the vast majority of FCs of aware patients preferred CDD suggests that the reaction of Egyptian patients to CDD is acceptable by FCs. Family caregivers with a negative attitude toward CDD may be reflecting their own fears.

Cancer disclosure-account from a pediatric oncology ward in Egypt

OBJECTIVE

Informing the child about his/her diagnosis and treatment plan is essential; research has shown that it is related to the patient's quality of life and adherence to medication.

METHODS

For 7 months during 2008 (February to September), 2 study-specific questionnaires were constructed and administered to 304 parents of children diagnosed with cancer at the Children's Cancer Hospital Egypt.

RESULTS

Among the 313 eligible parents of children diagnosed with cancer, 304 (97%) answered the first questionnaire and 281 (92%) answered the second questionnaire. We found that nearly three-quarters (72%) of the parents had their child's cancer diagnosis communicated by the physician. Among the 72%, the rate of the children present with the parent or parents during the disease disclosure conversation was 39% (n = 85/219). The majority of the children were in the age group 5-18 years (55%).

CONCLUSIONS

Our findings indicate that cancer disclosure at the Children's Cancer Hospital is to a certain degree common; yet even when disclosure does take place, it is mainly in the absence of the child. Moreover, the information provided during the conversation may not be fully comprehended by the parent or the child because of the physician's misleading use of terms when disclosing the disease. Therefore, better practice should be developed for disease disclosure, and proper communication should be established between the patients and the provider; patient autonomy should also have an influence in the clinical practice.

Cancer diagnosis disclosure from Portuguese physicians

Objective:

Doctor–patient communication in oncology, particularly concerning diagnostic disclosure, is a crucial factor related to the quality of the doctor–patient relationship and the psychological state of the patient. The aims of our study were to investigate physicians' opinions and practice with respect to disclosure of a cancer diagnosis and to explore potential related factors.

Method:

A self-report questionnaire developed for our study was responded to by 120 physicians from Coimbra University Hospital Centre and its primary healthcare units.

Results:

Some 91.7% of physician respondents generally disclosed a diagnosis, and 94.2% were of the opinion that the patient knowing the truth about a diagnosis had a positive effect on the doctor–patient relationship. A need for training about communicating with oncology patients was reported by 85.8% of participants. The main factors determining what information to provide to patients were: (1) patient intellectual and cultural level, (2) patient desire to know the truth, and (3) the existence of family.

Significance of results:

Our results point to a paradigm shift in communication with cancer patients where disclosure of the diagnosis should be made part of general clinical practice. Nevertheless, physicians still experience difficulties in revealing cancer diagnoses to patients and often lack the skills to deal with a patient's emotional responses, which suggests that more attention needs to be focused on communication skills training programs.

Truth-telling and hematopoietic stem cell transplantation

Background:

Hematopoietic stem cell transplantation is a potential cure for a range of life-threatening diseases, but is also associated with a high mortality rate. Nurses encounter a variety of situations wherein they are faced with discussing bad news with hematopoietic stem cell transplantation patients.

Research objective:

The aim of this study was to explore the experiences and strategies used by Iranian nurses related to truth-telling and communicating bad news to hematopoietic stem cell transplantation patients.

Research design:

A qualitative approach using content analysis of interview data was conducted.

Participants and research context:

A total of 18 nurses from the main hematopoietic stem cell transplantation center in Iran participated in semi-structured interviews.

Ethical considerations:

The Institutional Review Board of the Tabriz University of Medical Sciences and the Hematology-Oncology and Stem Cell Transplantation Research Center affiliated with the Tehran University of Medical Sciences approved the study.

Findings:

In the first main category, not talking about the disease and potential negative outcomes, the nurses described the strategies of not naming the disease, talking about the truth in indirect ways and telling gradually. In the second main category, not disclosing the sad truth, the nurses described the strategies of protecting patients from upsetting information, secrecy, denying the truth and minimizing the importance of the problem. The nurses used these strategies to minimize psychological harm, avoid patient demoralization, and improve the patient’s likelihood of a fast and full recovery.

Discussion:

The priority for Iranian hematopoietic stem cell transplantation nurses is to first do no harm and to help patients maintain hope. This reflects the Iranian healthcare environment wherein communicating the truth to hematopoietic stem cell transplantation patients is commonly considered inappropriate and avoided.

Conclusion:

Iranian nurses require education and support to engage in therapeutic, culturally appropriate communication that emphasizes effective techniques for telling the truth and breaking bad news, thereby potentially improving patient outcomes and protecting patient rights.

Students meeting with caregivers of cancer patient: results of an experience-based learning project

The communication between medical students and cancer caregivers, and the problems they have experienced as well as the outcomes for their professional development before starting clinical practice was assessed in the context of a student research project. Data were collected by questionnaires or by 20 to 40-min long interviews with cancer caregivers. Their communications with physicians, hearing the bad news, and health service satisfaction were questioned. Therefore, the caregivers trusted the professional approach of their physician. However, they expected more empathic communication in the process of diagnosis and therapy. Development of empathy and trust-based communication between patients and physicians and enhancement of the quality of devoted time to cancer patients and caregivers may have an effect on the course of disease. Interviewer students mentioned that they developed communication skills about difficult clinical tasks and in delivering bad news face to face to cancer caregivers before starting their clinical education.

Attitudes, beliefs and perceptions regarding truth disclosure of cancer-related information in the Middle East: a review

The aim of this review is to evaluate the current status concerning attitudes, beliefs and/or practices of patients, family members, health professionals and/or caregivers regarding truth disclosure about a cancer diagnosis in the Greater Middle East countries. A search was done via MedLine for all publications related to this review objective. 55 publications were included emanating from Egypt, Iran, Israel, Jordan, Kuwait, Lebanon, Palestine Pakistan, Saudi Arabia, Turkey, and United Arab Emirates. In the Greater Middle East region, a diagnosis of cancer is still mixed with social stigma and misperceptions related to incurability. Physicians conserve a truth disclosure policy in which from one side they respect some of the historical and cultural misperceptions about cancer and accordingly, tell the truth about cancer to one of the family members and from another side acknowledge the patients' right to know the truth and tend to disclose it for him(or her) when possible. Family members and caregivers' attitudes, perceptions and beliefs about telling the truth to the patient seem to be in favor of concealment. Discrepant results concerning physicians' and patients' evaluation of the quality of truth disclosure exist in the literature. Education programs in breaking bad news are lacking in many countries. Finally, the most important and common problem affecting truth disclosure to a patient suffering from cancer is the lack of codes and legislations concerning the patients' rights in an informed consent. Studies, legislations and training programs are needed in this domain in Middle Eastern societies.

Perspectives on care and communication involving incurably ill Turkish and Moroccan patients, relatives and professionals: a systematic literature review

Background

Our aim was to obtain a clearer picture of the relevant care experiences and care perceptions of incurably ill Turkish and Moroccan patients, their relatives and professional care providers, as well as of communication and decision-making patterns at the end of life. The ultimate objective is to improve palliative care for Turkish and Moroccan immigrants in the Netherlands, by taking account of socio-cultural factors in the guidelines for palliative care.

Methods

A systematic literature review was undertaken. The data sources were seventeen national and international literature databases, four Dutch journals dedicated to palliative care and 37 websites of relevant national and international organizations. All the references found were checked to see whether they met the structured inclusion criteria. Inclusion was limited to publications dealing with primary empirical research on the relationship between socio-cultural factors and the health or care situation of Turkish or Moroccan patients with an oncological or incurable disease. The selection was made by first reading the titles and abstracts and subsequently the full texts. The process of deciding which studies to include was carried out by two reviewers independently. A generic appraisal instrument was applied to assess the methodological quality.

Results

Fifty-seven studies were found that reported findings for the countries of origin (mainly Turkey) and the immigrant host countries (mainly the Netherlands). The central themes were experiences and perceptions of family care, professional care, end-of-life care and communication. Family care is considered a duty, even when such care becomes a severe burden for the main female family caregiver in particular. Professional hospital care is preferred by many of the patients and relatives because they are looking for a cure and security. End-of-life care is strongly influenced by the continuing hope for recovery. Relatives are often quite influential in end-of-life decisions, such as the decision to withdraw or withhold treatments. The diagnosis, prognosis and end-of-life decisions are seldom discussed with the patient, and communication about pain and mental problems is often limited. Language barriers and the dominance of the family may exacerbate communication problems.

Conclusions

This review confirms the view that family members of patients with a Turkish or Moroccan background have a central role in care, communication and decision making at the end of life. This, in combination with their continuing hope for the patient’s recovery may inhibit open communication between patients, relatives and professionals as partners in palliative care. This implies that organizations and professionals involved in palliative care should take patients’ socio-cultural characteristics into account and incorporate cultural sensitivity into care standards and care practices.

Public attitudes toward cancer and cancer patients: a national survey in Korea

BACKGROUND

Regardless of improved survival rate, negative images and myths about cancer still abound. Cancer stigma may reduce patients' life opportunities resulting in social isolation, decreased level of emotional well-being, and poor health outcomes. This study was aimed to evaluate public attitudes toward cancer and cancer patients and people's willingness to disclose cancer diagnosis in South Korea.

METHODS

A cross-sectional survey was conducted in August and September 2009. A nationally representative sample of 1011 men and women with no history of cancer was recruited. A set of 12 questions grouped into three domains (impossibility of recovery, cancer stereotypes, and discrimination) was used to assess public attitudes toward cancer.

RESULTS

It was found 58.5% of study participants agreed that it is impossible to treat cancer regardless of highly developed medical science, 71.8% agreed that cancer patients would not be able to make contributions to society, and 23.5% agreed that they would avoid working with persons who have cancer. The proportions of people who said that that they would not disclose a cancer diagnosis to family, friends or neighbors, or coworkers were 30.2%, 47.0%, and 50.7%, respectively. Negative attitudes toward cancer were strongly associated with lower willingness to disclose a cancer diagnosis.

CONCLUSIONS

Negative attitudes, stereotypes, and discriminating attitudes toward cancer and people affected by the disease were very common in spite of clinical progress and improved survivorship.

IMPACT

Our findings emphasize the need for health policy and social changes to provide a more supportive environment for cancer survivors.

Quality of sleep in Turkish family caregivers of cancer patients

The aim of this research was to determine the quality of sleep, reasons for sleep disturbances, and nonpharmacological strategies versus sleep disturbances of cancer patients' family caregivers. A descriptive, cross-sectional study design was used. Ninety family caregivers were included. Data were collected using the Pittsburgh Sleep Quality Index (PSQI), demographic data form, and open-ended questions about reasons for sleep disturbances and nonpharmacological strategies used by family caregivers. Descriptive statistics, Kruskal-Wallis variance analysis, and Bonferoni-corrected Mann-Whitney U test were performed using SPSS program. The PSQI score of 72.22% of the caregivers was above 5, which indicated poor sleep quality. The most commonly determined reasons for sleep disturbances were "emotional distress because of the patient's illness" (83.33%), "financial problems" (36.66%), and "inadequate support system" (34.44%); 76.92% of caregivers used at least 1 nonpharmacological strategy, which included mostly "lifestyle practices" (54.28%) and "behavioral practices" (25.71%). The total PSQI scores of caregivers having an illness were significantly higher than those of caregivers having no illness (Z = 3.230; P = .001). Total PSQI scores did not differ by sex, age, education, marital status, or duration of caregiving (P > .05). This study implies that caregivers are in need of support by healthcare professionals to provide a positive environment during the care process.

'Palliative care': a contradiction in terms? A qualitative study of cancer patients with a Turkish or Moroccan background, their relatives and care providers

Background

Palliative cancer care aims to improve quality of life and ultimately quality of dying, while prolonging life is not an objective anymore when death nears. The question is, however, whether these perspectives on palliative care are congruent with the perspectives of immigrant families with a Turkish or Moroccan background.

Methods

A qualitative design was used as we were looking for the personal views of 'very ill' cancer patients with a Turkish or Moroccan background, their family members and their Dutch care providers. We interviewed 83 people, involved in 33 cases to obtain information about their views, values and norms on 'good care'.

Results

The main concerns about 'good care' expressed by Turkish and Moroccan families were: maximum treatment and curative care until the end of their lives, never having hope taken away, devoted care by their families, avoiding shameful situations, dying with a clear mind and being buried in their own country. Their views conflict, to some extent, with the dominant principles in palliative care, for example, the emphasis on quality of life and advanced care planning, which includes discussing diagnosis and prognosis with the patient.

Conclusions

Patients and their families with a Turkish or Moroccan background often have different ideas about 'good care' than their Dutch care providers. As many of them are aiming at cure until the end of life, they find 'good palliative care' a contradiction in terms.

[Fourteen-year attitude survey on cancer disclosure to new outpatients of urology department]

PURPOSE

To investigate if timing of first visit, ages, sex, family history of cancer, and smoking history would cause any differences in patients' attitude toward cancer disclosure.

SUBJECTS AND METHODS

Subjects were 10,552 patients who first visited Urology Department of Nihonkai Hospital between 1993 and 2007, and were asked to fill in the questionnaire. The questionnaire contents are as follows: "If you were diagnosed as having cancer, would you like to be informed about the diagnosis of your disease?", and "If your families were diagnosed as having cancer, would you like to inform them about the diagnosis of their disease?". The subjects were asked to select their answers from the following options: (1) "fully informed", (2) "informed only when it is curable", (3) "not informed", and (4) "can not decide now". The relation of patients' attitude toward cancer disclosure with the timing of first visit, ages, sex, family history of cancer, and smoking history was investigated.

RESULTS

The response rate was approximately 80%. If the subjects would have cancer, 71.5% preferred to be informed ("fully informed" or "informed if it is curable"), and 9.2% did not. If the subjects' family would have cancer, 55.5% preferred their family to be informed ("fully informed" or "informed if it is curable"), and 14.9% did not. As it became more recent, both the rate of subjects who did not prefer to be informed (11.5% in 1993-1995, and 8.0% in 2005-2007) and the rate of those who did not prefer their family to be informed (18.6% in 1993-1995, and 11.0% in 2005-2007) decreased. Young subjects, men, and smokers more preferred to be informed. The subjects who had family history of cancer more preferred to inform them, but less to inform their family.

CONCLUSIONS

As it became more recent, both the subjects who did not prefer to be informed and those who did not prefer their family to be informed decreased. The idea that cancer disclosure was necessary to select the treatment methods based on each patient's preference and decision had been pervasive.

Not telling the truth: circumstances leading to concealment of diagnosis and prognosis from cancer patients

While autonomy has gradually become a key concept in the doctor-patient relationship, truth-telling is far from being the norm in many countries in the world. Despite the general agreement on the benefits of open communication between physicians and cancer patients, there is still strong resistance against disclosure of cancer diagnosis and prognosis in many cultures. Although fear of causing psychological morbidity to patients and their reluctance to find out the truth are two main justifications of non-disclosure attitudes, there are other important contributing factors that need to be further explored and better understood including those related to the relatives, doctors and healthcare systems. Cultural disparities in attitudes towards truth-telling persist; however, these differences should not be used as excuses not to respect the rights and individual preferences of cancer patients by making assumptions based on their age, sex, type of cancer, language and/or cultural background.