Breaking bad news in palliative care settings: a qualitative study from Northern Ghana

Effective communication is critical in palliative care, especially when breaking bad news. However, little is known about how patients, family members, and healthcare professionals experience communication during the breaking of bad news in palliative care settings in Northern Ghana. Understanding these experiences may provide insight for improving culturally responsive communication practices. This study explored the communication approaches used by healthcare professionals in breaking bad news and examined the experiences, responses, coping strategies, and disclosure preferences of patients, family members, and healthcare professionals in a palliative care setting in Northern Ghana. An interpretive phenomenological design was employed. Seventeen participants comprising five patients, five family members, and seven healthcare professionals were purposively recruited from a tertiary hospital in Northern Ghana. Data were generated through semi-structured interviews and analysed using reflexive thematic analysis. Voyant Tools was used as a supplementary tool to identify recurring word patterns in the data. Two major themes were identified: (1) communication experiences and disclosure preferences and (2) emotional responses and coping strategies. Healthcare professionals reported adopting both structured communication approaches, including the SPIKES protocol, and adaptive context-specific strategies. Patients generally preferred direct disclosure of bad news, with family members present. In contrast, family members generally supported withholding information to protect patients from emotional stress. One healthcare professional described this as an ethical dilemma. Participants reported intense emotional reactions to bad news, including shock, fear, sadness, and uncertainty. Spirituality, family support, previous caregiving experience, professional debriefing, and clear communication emerged as important coping mechanisms. Language barriers and cultural beliefs also influenced the interpretations of of bad news. The breaking of bad news in palliative care in Northern Ghana is influenced by the interplay of patient autonomy, family involvement, cultural values and professional responsibility. Patients preferred direct disclosure of bad news, while family members supported protective non-disclosure, creating an ethical dilemma for healthcare professionals. Healthcare facilities may consider culturally responsive communication training, establish disclosure guidelines, and provide or strengthen emotional support services to improve communication in palliative care.