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Original research
The 6-star doctor? Physicians’ communication of poor prognosis to patients and their families in Cape Coast, Ghana
  1. Alexandra Caulfield1,
  2. Amelie Plymoth2,
  3. Yvonne Ayerki Nartey2,
  4. Helle Mölsted-Alvesson1
  1. 1Department of Global Public Health, Karolinska Institute, Stockholm, Stockholm County, Sweden
  2. 2Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Stockholm County, Sweden
  1. Correspondence to Alexandra Caulfield; a.caulfield1{at}nhs.net

Abstract

Introduction Communication is considered a key skill for physicians globally and has formed a central part of medical curricula since the WHO identified it as a key attribute of the ‘5-star doctor’. Communication of poor prognosis to patients and caregivers is particularly challenging, yet an important example of physicians’ clinical communication, and a priority within palliative care research. Knowledge is scarce regarding the different positions physicians adopt during poor prognosis communication, especially in sub-Saharan countries.

Methods This qualitative study took place at the Cape Coast Teaching Hospital in Ghana’s Central Region. Physicians in the internal medicine department, with experience in communicating poor prognosis to patients and families on a weekly basis were purposively sampled. Based on the concept of information power, a maximum variation of participants, in terms of age, sex, seniority and experience was achieved after conducting 10 semistructured interviews in March 2019. Positioning theory was used as a theoretical lens to inform study design. The data were analysed through a constructivist thematic analysis approach.

Results Physicians adopted six positions, considered as six different themes, during their communication of poor prognosis: clinical expert, educator, counsellor, communicator, protector and mentor. Physicians’ choice of position was fluid, guided by local context and wider health system factors. Physicians’ desire to communicate with patients and families in a way that met their needs highlighted three key challenges for communication of poor prognosis: linguistic difficulties, pluralistic health beliefs and the role of family. These challenges presented ethical complexities in relation to autonomy and non-maleficence.

Conclusion Context is key to physicians’ communication of poor prognosis. Communication of poor prognosis is multifaceted, complex and unpredictable. Physicians’ communication training should be developed to emphasise contextual circumstances and physician support, and international policy models on physicians’ roles developed to include a greater focus on social accountability.

  • health policy
  • qualitative study
  • other infection, disease, disorder, or injury
  • cancer
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjgh-2020-002334

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    Footnotes

    • Handling editor Stephanie M Topp

    • Contributors AC, YAN, AP and HM-A made significant contributions to the study’s conception and design. AC, YAN and HM-A participated in and/or were consulted during data collection in Cape Coast. The interview guide was designed by AC, YAN and HM-A. Data analysis was conducted primarily by AC, YAN and HM-A. Figures were designed by AC. All authors have revised the manuscript and cleared it for publication. All authors take responsibility for the content and ensure accuracy for the manuscript in full.

    • Funding The study received funding from the Swedish Research Council (Vetenskapsrådet).

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Ethics approval Ethical approval for the study was granted by CCTH Ethical Review Board (Ref: CCTHERC/EC/2019/01).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request.