Cultural differences in truth-telling to cancer patients: Chinese and American approaches to the disclosure of ‘bad news’

A central challenge of the palliative care clinician, and of the oncologist who sees patients with advance disease, is that of ‘breaking bad news’. As this conversation requires that the clinician divulge extremely sensitive and personal information, and usually incurs an emotional response from the patient, truth-telling to advanced cancer patients is not only a challenging task but also one likely to be handled differently in cultures according to differing norms for interpersonal behavior and communication. China and the United States, with their deepset communitarian vs. individualistic ethics, respectively, typify divergent cultures. This paper discusses cross-cultural differences in norms of truth-telling to cancer patients, that is, the extent to which physicians inform patients themselves of their disease status when prognosis is poor; China and the US are used to illustrating potential differences in approach and consequent cross-cultural misunderstandings. In an increasingly mobile global community, in which information technology and telecommunications span cultures and patients are increasingly well informed, clinicians around the world would be well advised to become aware of the communication styles and expectations, and to make an effort to understand the norms, of their patients’ cultures of origin.