Disclosure of gynecological cancer diagnosis: a mixed-methods study from an Islamic cultural context

Delivering devastating news of cancer is a universal challenge, but cultural and religious contexts impact disclosure. In Saudi Arabia, family engagement frequently influences communication, yet little is known about stakeholders' perspectives on gynecological cancer.

This mixed-methods study used validated questionnaires and semi-structured interviews.

A total of 737 participants were included (54.1% public, 18.5% physicians, 16.0% relatives, and 11.4% patients); the majority were female (67.8%) and Saudi citizens (81.9%), with a median age of 38 years.

Overall, 90.5% of participants preferred that a cancer diagnosis be disclosed to the patient rather than withheld. However, only 25-36% supported disclosing a bad prognosis, with physicians being the least supportive (6.7%, p < 0.0001). Most groups supported the use of the term "chemotherapy" (88-98%). 94% of clinicians favored disclosing treatment failure, but only 61% of patients and 53% of the public agreed (p < 0.0001). More than half of patients (51.5%) and three-quarters of clinicians (73.1%) were opposed to concealing diagnoses at the request of the family. Patients greatly preferred engagement in treatment (66.3%) and end-of-life talks (80.7%), whereas physicians showed less support. In terms of communication dynamics, most patients preferred that the head of the medical team disclose directly to them, face-to-face, and framed with "Allah's will."

Although patients, family, the public, and clinicians mostly supported direct disclosure, there were still disagreements over prognosis and end-of-life talks. These findings emphasize the importance of culturally sensitive, ethically based communication training to enhance patient-centered treatment in gynecological oncology.