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Communicating the diagnosis of cancer in cross-cultural clinical settings is a complex task. This qualitative research article describes the content and process of informing Zulu patients in South Africa of the diagnosis of cancer, using osteosarcoma as the index diagnosis. We used a descriptive research design with census sampling and focus group interviews. We used an iterative thematic data analysis process and Guba's model of trustworthiness to ensure scientific rigor. Our results reinforced the use of well-accepted strategies for communicating the diagnosis of cancer. In addition, new strategies emerged which may be useful in other cross-cultural settings. These strategies included using the stages of cancer to explain the disease and its progression and instilling hope using a multidisciplinary team care model. We identified several patients, professionals, and organizational factors that complicate cross-cultural communication. We conclude by recommending the development of protocols for communication in these cross-cultural clinical settings.

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

Purpose: International and national research regarding the discussion of cancer treatment across cultural boundaries is sparse. This study was conducted in the province of KwaZulu-Natal, South Africa, where healthcare encounters are largely culturally discordant; and this study focused on adult Zulu patients diagnosed with osteosarcoma. The purpose of this research study was to identify the cultural factors associated with discussing the different treatment options – and to explore healthcare professionals’ responses to these cultural factors – from the healthcare professionals’ perspective. Methods: A qualitative, exploratory, descriptive and contextual research design was used. We conducted focus group interviews with professional nurses, allied health professionals and orthopaedic physicians. These three focus groups comprised a total of 23 participants, and interviews were conducted with each of these groups. We thematically analysed the interview transcripts, using Guba’s model of trustworthiness to ensure rigour. Results: We found that the factors, influencing treatment discussions in this cross-cultural clinical setting, included the meaning and the disclosure of cultural health beliefs. We identified strategies for responding to the cultural factors associated with amputation, namely timing treatment discussions, using support services, patient models and DVDs or videos. Strategies for responding to cultural and health beliefs that affect the treatment included initiating the cultural discussion, demonstrating an understanding of patients’ cultural beliefs and liaising with family and cultural decision-makers wherever possible. Conclusion: Our findings emphasised healthcare professionals’ reports of how patients can experience the discussion of culturally discordant treatment options as bad news. We recommend that the treatment discussion form an integral part of the guidelines for culturally competent communication with such cancer patients.

Background: Managing cancer in a multicultural environment poses several challenges, which include the communication between the patient and the healthcare provider. Culture is an important consideration in clinical care as it contributes to shaping patients’ health-related values, beliefs, and behaviours. This integrative literature review gathered evidence on how culturally competent patient–provider communication should be delivered to patients diagnosed with cancer.Design: Whittemore and Knafl’s approach to conducting an integrative literature review was used. A number of databases were systematically searched and a manual search was also conducted. Specific inclusion and exclusion criteria were set and documents were critically appraised independently by two reviewers. Thirty-five documents were included following these processes. Data extraction and synthesis followed and were also independently verified.Results: Various strategies and personal characteristics and attitudes for culturally competent communication were identified. The importance of culturally competent healthcare systems and models for culturally competent communication were also emphasised. The findings related to all themes should be treated with caution as the results are based mostly on low-level evidence (Level VII).Conclusions: More rigorous research yielding higher levels of evidence is needed in the field of culturally competent patient–provider communication in the management of cancer. Most of the available literature was classified as non-research evidence. The themes that emerged do, however, provide some insight into how culturally competent patient–provider communication may be delivered in order to improve treatment outcomes in patients diagnosed with cancer.Keywords: cultural competence; patient–provider communication; cancer; oncology; culture(Published: 30 November 2016)To access the supplementary material for this article, please see Supplementary files in the column to the right (under ‘Article Tools’).Citation: Glob Health Action 2016, 9: 33208 - http://dx.doi.org/10.3402/gha.v9.33208

Religion and spirituality are recognized coping resources but are neglected in psychological training and practice. However, religion and spirituality can be successfully used to cope with psychological disorders, prevent unhealthy behaviors and promote resilience. This study explored and described two questions regarding the concepts of the terminology religion and spirituality, and the perceptions of the use of religion and spirituality in therapy. Purposive sampling was utilized in a qualitative study of 15 registered psychologists, and data were analyzed using Tesch's model of qualitative content analysis. The concepts religion and spirituality appear difficult to define but the importance of their use as coping mechanisms in their own and their clients' lives was recognized. These findings have implications for professional training.

Background: This article investigates emotional intelligence and locus of control in an adult breast cancer population receiving treatment. Gaining insight into these constructs will contribute to improving breast cancer patients’ psychological well-being and to reducing physical vulnerability to disease before and during treatment.Method: The researcher used an exploratory, descriptive and correlational approach. Nonprobability purposive sampling was employed. Sixty-seven breast cancer patients receiving treatment participated in the research. A biographical questionnaire, the Schutte Emotional Intelligence Scale, and the Rotter Internal-External Locus of Control Scale were used to measure the constructs explored in this article. Descriptive and inferential statistics were used to analyse the data.Results: The sample yielded above-average levels of emotional intelligence and an internal locus of control. The results indicate a statistically and practically significant negative correlation between emotional intelligence and locus of control. The significant association found between higher and lower emotional intelligence groups and internal and external locus of control groups also confirmed these results.Conclusion: Having an understanding of the psychosocial variables that impact on individuals diagnosed with a chronic illness, in this case breast cancer, can assist interventionists working in the field of positive psychology. While the stressors and challenges that breast cancer patients face are well documented, this article highlights the strength factors emotional intelligence and locus of control as important mediators in the treatment and management of breast cancer.

This study sought to explore and describe the sense of coherence (SOC) and quality of life (QoL) in elderly people living with diabetes mellitus (DM). Participants were 72 elderly persons with DM (men = 19, women = 53, M (age) = 74.33, SD = 7.78). Data were collected using the Sense of Coherence Inventory (SOC-29) and WHOQOL-100. Cramer's V was used to assess the relationship between the SOC-29 and the WHOQOL-100. Results suggest that the elderly persons had a strong SOC and perceived themselves as having a satisfactory QoL. The correlational analysis revealed a significant positive relationship between these two measures for the current sample. Elderly persons with DM seemed to have personal resources and capacities for living well with their health condition.

The use of religion and spirituality in psychotherapy has been a contentious issue for decades. This paper explores and describes whether psychologists would use religion and spirituality in psychotherapy as well as enablers and barriers in this regard. A qualitative exploratory descriptive method was followed using purposive sampling to obtain a sample of clinical and counselling psychologists. The focus group strategy was used to collect the data, and Tesch's model of content analysis was used to analyse the qualitative findings. Most participants expressed a willingness to discuss religion and spirituality with their clients. Participants also highlighted specific enablers and barriers to incorporating religion and spirituality in psychotherapy. This article has the potential to influence professional training in psychology and psychotherapy.

There has been limited South African research to date on family resilience as well as on the resiliency of families living with children diagnosed with AD/HD. We aimed to explore and describe the factors that facilitate adjustment and adaptation in families after a child has been clinically diagnosed with AD/HD. The Resiliency Model of Family Stress, Adjustment and Adaptation served as a framework to conceptualize the families' adjustment and adaptation processes. The study was triangular in nature, with an exploratory, descriptive approach. Non-probability purposive sampling was used to gain participants for the study. A biographical questionnaire and seven structured questionnaires were used to gather data. The biographical data were analysed using descriptive statistics. Quantitative data were analysed by means of correlation analysis, and content analysis was used to analyse the qualitative data obtained from the open-ended question on the biographical questionnaire. While the results of the quantitative analysis and qualitative analysis yielded various results, some commonalities can be highlighted; social support, family time and routines, and incendiary (affirmative) communication. The study sample also demonstrated their ability to bounce back from the adversities that previous research consistently highlighted as difficulties in their context. The findings of the research can be incorporated into individual and family level interventions for families living with a child diagnosed with AD/HD.

Stress in the teaching profession is a well-recognized phenomenon and, in addition, research has found special education to be more demanding than mainstream education. A literature study to date revealed that international and South African research on special education teachers and their coping with stress is sparse. We therefore aimed to explore and describe the coping orientation and resources of teachers educating learners with intellectual disabilities. An exploratory, descriptive survey design was employed in the study. Antonovsky's Orientation to Life Questionnaire (SOC-29) and Hammer and Mailing's Coping Resources Inventory (CRI) was administered to 59 special education teachers in the Nelson Mandela Metropole, South Africa. Key findings revealed fairly high mean scores on the SOC-29 and average mean scores on the CRI. Significant positive correlations between the SOC-29 and the CRI total mean score and some of the subscale scores of the CRI were also evident.

Most research on professional women has focused on their stress experience as opposed to their coping and adjustment. In addition, there is a paucity of South African research on coping in general, and on coping and adjustment among medical professional women in particular. This study accordingly investigated the biopsychosocial coping and adjustment of medical professional women in South Africa, by means of an exploratory, descriptive research design. The relationship between participants' scores on coping and adjustment measures was also explored. Three measures were used, namely, a biographical questionnaire, the Coping Resources Inventory (CRI) and the Personal, Home, Social and Formal Relations Questionnaire (PHSF). These were administered to 66 medical professional women in the Nelson Mandela Metropole. The results indicated that the participants perceived themselves as having an average level of coping resources and adjustment. A significant positive relationship was found to exist between coping resources and adjustment. These results are discussed in terms of their relevance to future research and their practical applicability in terms of support structures for medical professional women.

Background: Despite the multitude of challenges that families living with a child with diabetes face, they have been found to adapt to such an extent that diabetes is viewed as a manageable condition. This study was concerned with the factors that enable these families to adapt. The internationally acclaimed Resiliency Model of Stress, Adjustment and Adaptation served as the framework to conceptualise the families’ adjustment and adaptation processes.Methods: The study was triangular in nature, with an exploratory, descriptive approach; non-probability purposive and snowball sampling techniques were employed. Sixteen families participated in the research. A biographical questionnaire, which included an open-ended question, to be completed in written format, was used in conjunction with seven structuredquestionnaires to gather relevant data. These seven structured questionnaires were an operationalisation of some of the key concepts and processes of the Resiliency Model. Descriptive statistics were used to describe the biographical information.Quantitative data were analysed by means of correlation analysis, while qualitative data were analysed by means of content analysis.Results: Various resilience factors were highlighted, including family time and routines, communication, hardiness, the acceptance of the diabetes, adherence to a treatment regimen, the obtaining of knowledge and skills, and working together as a family unit in managing the diabetes.Conclusions: Family plays a powerful role both in the treatment of chronic illness and in paediatric practice. This article highlights the central role of family in the management of type I diabetes and provides practitioners with insight into the challenges that families face, as well as the strengths that can be developed to improve their resilience in relation to this chronic illness. The identified variables are valuable, in that they can be used as a map to guide prevention and intervention efforts in helping families live with type I diabetes.Keywords: Type I diabetes; family resilience; the Resiliency Model of Family Stress, Adjustment and Adaptation; chronic illness management; family adaptation; family challenge