Truth-telling and hematopoietic stem cell transplantation: Iranian nurses' experiences

摘要

Background: Hematopoietic stem cell transplantation is a potential cure for a range of life-threateningdiseases, but is also associated with a high mortality rate. Nurses encounter a variety of situations whereinthey 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 Iraniannurses related to truth-telling and communicating bad news to hematopoietic stem cell transplantationpatients.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 celltransplantation center in Iran participated in semi-structured interviews.Ethical considerations: The Institutional Review Board of the Tabriz University of Medical Sciences andthe Hematology-Oncology and Stem Cell Transplantation Research Center affiliated with the Tehran Universityof Medical Sciences approved the study.Findings: In the first main category, not talking about the disease and potential negative outcomes, thenurses described the strategies of not naming the disease, talking about the truth in indirect ways andtelling gradually. In the second main category, not disclosing the sad truth, the nurses described thestrategies of protecting patients from upsetting information, secrecy, denying the truth and minimizingthe importance of the problem. The nurses used these strategies to minimize psychological harm, avoidpatient 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 harmand to help patients maintain hope. This reflects the Iranian healthcare environment whereincommunicating the truth to hematopoietic stem cell transplantation patients is commonly consideredinappropriate and avoided. Conclusion: Iranian nurses require education and support to engage in therapeutic, culturally appropriatecommunication that emphasizes effective techniques for telling the truth and breaking bad news, therebypotentially improving patient outcomes and protecting patient rights.