title: Perceptions of patients, families, physicians and nurses regarding challenges in cancer disclosure: A descriptive qualitative study.
abstract: OBJECTIVE
  The findings of numerous studies have illustrated that there is still a high proportion of cancer patients in Eastern and Middle-East countries including Iran, who are not properly informed of their disease due to the concealment atmosphere which still prevails. This descriptive qualitative study is aimed at exploring perceptions of patients, patients' family members, physicians and nurses regarding cancer disclosure challenges.
  
  
  METHODS
  Thirty-five participants (15 patients, 6 family members, 9 physicians, and 5 nurses) were selected through purposive sampling. The data were collected through in-depth interviews; after which they were analyzed using a qualitative content analysis with an inductive approach.
  
  
  RESULTS
  Data analysis revealed the following three categories: first, challenges related to healthcare system which deals with the deficiencies, strains and concerns in medical setting and healthcare team training; second, challenges related to family insistence on concealment which includes their fear of cancer disclosure and its negative impact on the patients; and third, challenges related to policy making which consists of deficiencies in legislative and supportive institutions for advocacy of truth telling.
  
  
  CONCLUSIONS
  Successful move from concealment to effective disclosure attitude in cancer patients in Iran requires a national determination for resolving challenges in medical education as well as other different social, cultural and policy making dimensions.
authors.affiliation: Students Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran. Electronic address: maryam_ehsani@nm.mui.ac.ir.
authors.forename: Maryam
authors.initials: M
authors.lastname: Ehsani
authors.affiliation: Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran. Electronic address: taleghani@nm.mui.ac.ir.
authors.forename: Fariba
authors.initials: F
authors.lastname: Taleghani
authors.affiliation: Radiotherapy and Oncology Department, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Electronic address: hematti@med.mui.ac.ir.
authors.forename: Simin
authors.initials: S
authors.lastname: Hematti
authors.affiliation: Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran. Electronic address: abazari@nm.mui.ac.ir.
authors.forename: Parvaneh
authors.initials: P
authors.lastname: Abazari
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D007492:Iran; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D009726:Nurses / Q000523:psychology*; D010361:Patients / Q000523:psychology*; D010465:Perception; D010820:Physicians / Q000523:psychology*; D036301:Qualitative Research; D057545:Social Stigma; D014342:Truth Disclosure; D055815:Young Adult
keywords: Breaking bad news; Cancer disclosure; Qualitative study