

































 
  

 

 

  

Disclosure of Diagnosis and Prognosis Information of Cancer in Jordan: Comparative Analysis 

  1. Assistant Professor, Khaldoon alnawafleh, 

1Al-Hussein Bin Talal University, Princess Aisha Bint Al-Hussein Faculty of Nursing and Health Sciences. 

Khaldoon.nawafleh@ahu.edu.jo 

2. Walid Theib Mohammad 

Al-Hussein Bin Talal University  Princess Aisha Bint Al Hussein College for Nursing and Health 

Sciences Princess Aisha Nursing College 

9901002@ahu.edu.jo  

Abstract 

There is no common disclosure practice among healthcare providers when it comes to cancer diagnosis, 

whether to tell or not to tell. The lack of a clear policy for healthcare practitioners, who face this dilemma 

every day in their professional practice, further complicates the situation. The aim of this review is to 

attempts to look into what governs the public attitude towards disclosure in Jordan as an example of what 

may affect attitudes in developing countries. Also brings some data from national research among 

physicians and patients as well as from public surveys to describe the changing attitude over the years 

with a comparative analysis of the Western literature, A search was done via MedLine for all publications 

related to this review objective  were included emanating from Jordan and western countries (USA, 

Australia and UK). The findings showed that Western countries have high levels of reported disclosure 

compared to Jordan, which has a slight growth in disclosure due to some obstacles in the sociocultural 

constructs lacks patient education resources and low health literacy. 

Key words: Cancer, decision making, information provision, Jordanian, physicians

IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING   (ISSN: 2805-413X)

Volume 4 | Issue 11 | November 2021 |                      http://ijojournals.com/index.php/hsn 1

mailto:Khaldoon.nawafleh@ahu.edu.jo
mailto:9901002@ahu.edu.jo


                                                                                                                                      
                                                                                                                                                                                                        
                                                                                                                                                       

  

Introduction 

    Cancer is a complicated illness, represents a significant event that changes 

individuals’ life trajectory. Cancer meant death, usually perceived by patients as 

highly stressful, resulting in fear, shock, depression, and unresolved denial (Jaiswal& 

Breitbart, 2014). There is no agreement among health care providers on a unified 

disclosure practice, either to say it or not. This is a complex issue due to the lack of 

evidence Policy for healthcare practitioners, who each face this issue a day in their 

clinical practice (Ni & Alræk, 2017). 

    Disclosing a terminal diagnosis or prognosis to their patients, clinicians have been 

described as intermediaries or master of ceremonies" to the transition from health to 

life-threatening illness and for some, death (Wolfreys, 2016). Disclosure and truth-

telling can be overwhelming emotionally for patients as well as for health care 

providers, who have a prior belief that there is no cure and death is linked to cancer 

(Rozveh et al., 2017). In most of these clinical situations, the family’s request for non-

disclosure of diagnosis or prognosis to the patient is the most contradicting and at the 

same time, the most difficult to manage. To appropriately respond to this request, 

physicians need to deeply understand the sociocultural 

background of such an attitude (Paternotte et al., 2015). 

     Disclosing the diagnosis or prognosis to cancer patients in Jordan can be a serious 

challenge to the physician in his daily clinic practice. The public attitude towards  

disclosure is still conservative, and in order to appropriately deal with such an 

attitude, physicians and nurses need to much understand its sociocultural background 

(Al Qadire, 2018).  

     This paper attempts to look into what governs the public attitude towards 

disclosure in Jordan as an example of what may affect attitudes in developing 

IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING   (ISSN: 2805-413X)

Volume 4 | Issue 11 | November 2021 |                      http://ijojournals.com/index.php/hsn 2



                                                                                                                                      
                                                                                                                                                                                                        
                                                                                                                                                       

  

countries. Also brings some data from national research among physicians and 

patients as well as from public surveys to describe the changing attitude over the years 

with a comparative analysis of the Western literature. 

Disclosure of Cancer in Jordan VS Western Countries 

     Many researchers have referred to a different perspective on the importance of 

disclosing cancer in their various studies. The following studies have been selected to 

compare disclosure in Jordan and western countries (USA, Australia and UK). 

    Studies by (Obeidat and Khrais, 2015), (Obeidat and Khrais, 2016), (Al Qadire, 

2018) and (Borgan et al., 2018). All of these studies were conducted for Jordan.    

According to Obeidat and Khrais (2016) was conducted a study to determine the 

attitude of Jordanian physicians toward disclosure of cancer information, comfort and 

use of different decision making approaches, and treatment decision making by used 

A descriptive comparative research design ,a convenience sample of 86 Jordanian 

medical , radiation oncologists and surgeons practicing mainly in oncology setting. 

The result of this study show that almost 91% of all physicians indicated that the 

doctor should tell the patient and let him/her decide if the family should know of an 

early stage cancer diagnosis. Similarly, Al Qadire (2018) conducted a study to explore 

Jordanian public preference on cancer diagnosis disclosure and the type of 

information they need by used A descriptive cross-sectional survey design and the 

sample consisted of 485 participants. The result of this study show 421 (86.8%) 

participants wanted to be informed of the diagnosis if they developed cancer. 

However, Obeidat and Khrais (2015) was conducted study to determine Jordanian 

women’s attitudes toward disclosure of breast cancer information and their 

information needs by used descriptive comparative research design among 156 

Jordanian women who had a confirmed first time diagnosis of breast cancer. The 

IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING   (ISSN: 2805-413X)

Volume 4 | Issue 11 | November 2021 |                      http://ijojournals.com/index.php/hsn 3



                                                                                                                                      
                                                                                                                                                                                                        
                                                                                                                                                       

  

result of this study show the vast majority of patients wanted to know whether the 

diagnosis was breast cancer (92%) and the stage of the disease (78%) and information 

about spread of the disease and chances of cure was of highest importance for the 

majority of the patients (88 % and 85 %). 

Borgan et al. (2018) was conducted study to explore the truth disclosure Practices of 

physicians in Jordan, a developing country. By used A descriptive cross sectional 

survey design and sample consisted of 240 physicians. The findings show that 77 % 

of physicians opted for a usual (Tell) policy. Surprisingly, specialists were more likely 

to have adopted a (Do not Tell) policy compared to non-specialists (34 % and 19 %), 

non-disclosure was primarily motivated by request from the patient’s family (71 

participants, 54 %).Most respondents opt to disclose the truth; However, the vast 

majority of these respondents make exceptions and instances of non-disclosure are 

primarily motivated by sociocultural constructs. 

    Obeidat and Khrais (2016) indicated that almost 48% of the participating 

physicians reported using shared decision making as their usual approach for 

treatment decision making; The cultural norms, in which patients are not accustomed 

to being involved in medical decision making, are rooted deep in Jordanian society 

and may be responsible for Jordanian patients’ willingness to play a passive role in 

treatment decision making. Al Qadire (2018) was found that people with a high 

monthly income requested more information, while the inhabitants of the southern 

region needed relatively less information than others related to economic status of 

participants. 

    On the other hand, other studies were conducted for western countries ; (Enzinger 

et al., 2015), (Chittem and Butow, 2015) and, (Munro et al., 2015) .Both  Enzinger et 

al. (2015) and Munro et al.(2015) have supported disclose information for patient. 

IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING   (ISSN: 2805-413X)

Volume 4 | Issue 11 | November 2021 |                      http://ijojournals.com/index.php/hsn 4



                                                                                                                                      
                                                                                                                                                                                                        
                                                                                                                                                       

  

According to Enzinger  et al. (2015) conducted a study in New York to determine 

how prognostic conversations influence perceptions of life expectancy (LE), distress, 

and the patient-physician relationship among patients with advanced cancer. That 

used multicenter observational study of 590 patients with metastatic solid 

malignancies with progressive disease after one line of palliative chemotherapy, 

undergoing follow-up to death. The results showed that 71% wanted to be told their 

LE, but only 17.6% recalled a prognostic disclosure by their physician .Similarly, 

Munro et al. (2015) conducted a study to identify disclosure patterns among patients 

with cancer and to determine the factors associated with disclosure among 120 

Patients who had received a diagnosis of either lung, colorectal or skin cancer in UK. 

The findings showed that the majority of patients (95%) found it helpful to disclose 

information and did so to a variety of social targets, with the highest levels of 

disclosure being reported to medical personnel. Additionally, Chittem and Butow 

(2015) Using the snowball method, 14 Australian (Western: 9, non Western: 5) 

oncologists to explore differences in the attitudes and practices of Western born and 

non Western born oncologists in Australia when faced with a nondisclosure request. 

The results showed that six main themes emerged from the study: (1) Barriers to 

truthful communication, (2) an ethical and moral dilemma, (3) high costs of 

nondisclosure, (4) cultural influences on interpretation and understanding of requests 

for nondisclosure, (5) emotional impact of bad news on patients, families and 

oncologists, and (6) truthful disclosure as a gentle balancing act. 

Discussion of Findings 

    The aim of this paper was to discuss seven published studies and compare the 

disclosure in Jordan versus in the western countries (Table 1). Jordanian researchers 

referred to several reference points related to the issue of patient disclosure. 

IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING   (ISSN: 2805-413X)

Volume 4 | Issue 11 | November 2021 |                      http://ijojournals.com/index.php/hsn 5



                                                                                                                                      
                                                                                                                                                                                                        
                                                                                                                                                       

  

According to Obeidat and Khrais (2016) indicated for important facts that the Jordan 

Ministry of Health website lacks patient education resources and low health literacy 

has been implicated as one of the major barriers for the successful implementation of 

shared decision making in clinical practice. This barrier is inconsistent with the results 

of the Al Qadire (2018) study it was found that the majority of Jordanians opted 

strongly for disclosure of cancer diagnosis, with high information needs about all 

aspects of cancer and its treatment. In the same way, Obeidat and Khrais (2015) 

indicated to the majority of Jordanian women wanted information about breast cancer 

diagnosis, chances of cure and treatment side effects.  

    Another obstacle to disclosure in Jordan is the sociocultural constructs and fear of 

psychological consequences is the most common reason for nondisclosure is a direct 

request to the respondent from the patient’s family, without the patient’s consent. This 

finding provides first-hand evidence of the strong presence of family centered care in 

Jordan (Borgan et al., 2018). 

    In comparison to western countries, the findings showed that high average levels of 

disclosure were reported to ‘family’ and ‘friends’ social subgroups expands the earlier 

work that has emphasized the importance of informal helpers and confidants. Higher 

levels of disclosure were also associated with higher levels of social support, 

confirming suggestions that social support systems provide an important context for 

disclosure (Munro et al., 2015).Also, western oncologists felt there were high costs of 

nondisclosure to patients and their families, they agreed that there were cultural 

influences on interpretation and understanding of requests for nondisclosure, they 

observed an emotional impact of bad news on patients, families and oncologists, and 

they believed that truthful disclosure was a gentle balancing act (Chittem& Butow, 

2015). Additionally, the increased optimism treatment in western country for some 

IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING   (ISSN: 2805-413X)

Volume 4 | Issue 11 | November 2021 |                      http://ijojournals.com/index.php/hsn 6



                                                                                                                                      
                                                                                                                                                                                                        
                                                                                                                                                       

  

cancers due to advances in surgical and radiation methods and the beginning of 

medical oncology gave more treatment options and increased survival in many 

cancers; This in turn provided the momentum toward disclosing diagnoses to patients 

(Enzinger et al., 2015). 

Conclusion 

    Attitudes are steadily passing, although their growth has been slow in many non-

Western countries, including Jordan. Public education and partial cultural openness 

due to the communication revolution, and worldwide globalization are having some 

effect in changing a few aspects of the sociocultural constructs in Jordan. Socially 

sanctioned roles in the patient provider relationship in non western countries, whose 

cultures are mostly family centered, are different from those in western countries 

(autonomous, self determinate patients and authoritative physicians). 

 

References 

Al Qadire, M. (2018). Disclosure of cancer diagnosis: an individualized and non-         

              paternalistic approach is preferred. Journal of Cancer Education, 33(5), 996-   

              1001. 

Borgan, S. M., Amarin, J. Z., Othman, A. K., Suradi, H. H., & Qwaider, Y. Z. (2018).  

            Truth disclosure practices of physicians in Jordan. Journal of bioethical                

            inquiry, 15(1), 81-87.  

Chittem, M., & Butow, P. (2015). Responding to family requests for nondisclosure:    

            The impact of oncologists' cultural background. Journal of Cancer Research         

            and Therapeutics, 11(1), 174 

Enzinger, A. C., Zhang, B., Schrag, D., & Prigerson, H. G. (2015). Outcomes of                

             prognostic disclosure: associations with prognostic understanding, distress,     

IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING   (ISSN: 2805-413X)

Volume 4 | Issue 11 | November 2021 |                      http://ijojournals.com/index.php/hsn 7



                                                                                                                                      
                                                                                                                                                                                                        
                                                                                                                                                       

  

             and relationship with physician among patients with advanced cancer. Journal 

            of clinical oncology, 33(32), 3809.  

Jaiswal, R., Alici, Y., & Breitbart, W. (2014). A comprehensive review of palliative     

           care in patients with cancer. International review of psychiatry, 26(1), 87-101.  

Munro, H., Scott, S. E., King, A., & Grunfeld, E. A. (2015). Patterns and predictors of    

          disclosure of a diagnosis of cancer. Psycho‐Oncology, 24(5), 508-514. 

Ni, Y. H., & Alræk, T. (2017). What circumstances lead to non-disclosure of cancer-  

         related information in China? A qualitative study. Supportive Care in                   

        Cancer, 25(3), 811-816.  

Obeidat, R., & Khrais, H. I. (2015). Information needs and disclosure preferences       

          among Jordanian women diagnosed with breast cancer. Journal of Cancer             

         Education, 30(1), 94-99.  

Obeidat, R., & Khrais, H. I. (2016). Jordanian physicians’ attitudes toward disclosure   

          of cancer information and patient participation in treatment decision-                   

          making. Asia-Pacific Journal of Oncology Nursing, 3(3), 281.  

Paternotte, E., van Dulmen, S., van der Lee, N., Scherpbier, A. J., & Scheele, F.           

          (2015). Factors influencing intercultural doctor–patient communication: A           

          realist review. Patient education and counseling, 98(4), 420-445.  

Rozveh, A. K., Amjad, R. N., Rozveh, J. K., & Rasouli, D. (2017). Attitudes toward    

        telling the truth to cancer patients in Iran: a review article. International journal  

        of hematology-oncology and stem cell research, 11(3), 178.  

Wolfreys, J. (2016). BeyondBreaking Bad News': clinicians' experiences of disclosing    

         a life-limiting illness to their patients.  

 

 

IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING   (ISSN: 2805-413X)

Volume 4 | Issue 11 | November 2021 |                      http://ijojournals.com/index.php/hsn 8



                                                                                                                                      
                                                                                                                                                                                                        
                                                                                                                                                       

  

Table 1. Summary of Studies that used in comparative analysis 

 

Summary of Findings 

 

Setting 

 

Approach/ 

Design/ Sample 

 

Objectives 

 

Authors/ 

Y\ears 

-Prognostic disclosure 

was not associated 

with worse patient-

physician relationship 

ratings, sadness, or 

anxiety in adjusted 

analyses. 

- Prognostic 

disclosures are 

associated with more 

realistic patient 

expectations of LE.  

 

New York 

(USA) 

-Quantitative 

- prospective study 

(cohort ) 

- 590 patients with 

advanced cancer 

patients with 

metastatic solid 

malignancies and 

progressive disease 

after one line of 

palliative 

chemotherapy 

 

-To determine 

how prognostic 

conversations 

influence 

perceptions of life 

expectancy (LE), 

distress, and the 

patient-physician 

relationship 

among patients 

with advanced 

cancer. 

Enzinger et 

al., (2015) 

-The majority of 
Jordanian 
women wanted 
information about 
breast cancer 
diagnosis, chances of 
cure, and treatment 
side effects 
 

 

Jordan 

-Quantitative 
method 
- descriptive 
comparative 
research design 
- A convenience 
sample of 156 
Jordanian women  

To determine 
Jordanian 
women’s attitudes 
toward 
disclosure of 
breast cancer 
information and 
their information 
needs. 

Obeidat, R., 

& Khrais, H. 

I. (2015). 

- All oncologists felt 
that the family request 
for nondisclosure was 
difficult, with many 
cultural and emotional 
nuances to take into 
consideration. Some 
immigrant Australian 
oncologists who had a 
similar cultural 
background as the 
patient/family, felt 
they could better 
understand the desire 
for nondisclosure. 

 

Australia 

- Using the 
snowball method, 
14 Australian 
(Western = 9, 
 non Western = 5) 
oncologists . 

- To explore 
differences in the 
attitudes and 
practices of 

Western‑born and 
nonWestern born 
oncologists in 
Australia when 
faced with a 

nondisclosure 

request. 

Chittem& 

Butow, 

(2015) 

IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING   (ISSN: 2805-413X)

Volume 4 | Issue 11 | November 2021 |                      http://ijojournals.com/index.php/hsn 9



                                                                                                                                      
                                                                                                                                                                                                        
                                                                                                                                                       

  

- The majority of 
patients (95%) found it 
helpful to disclose 
information and did so 
to a variety of social 
targets, with the 
highest levels of 
disclosure being 
reported to medical 
personnel 

 

London, UK 

-Quantitative 

method 

-descriptive 

research design 

- A convenience 

sample of 120 

cancer patients. 

 

-To identify 
disclosure 
patterns among 
patients with 
cancer and to 
determine the 
factors associated 

with disclosure 

Munro et 

al.(2015) 

 

- Almost 91% of all 

physicians indicated 

that the doctor should 

tell the patient and let 

him/her decide if the 

family should know of 

an early‑stage cancer 

diagnosis. 

- Physicians provide 

abundant information 

about the extent of the 

disease, the side 

effects and benefits of 

the treatment, and 

details of the treatment 

procedures  

 

Jordan 

-Quantitative 

Method 

-A descriptive, 

comparative 

research design 

was used. 

- convenience 

sample of 86 

Jordanian medical 

and radiation 

oncologists and 

surgeons practicing 

mainly in oncology 

was recruited. 

 

-To determine the 

attitude of 

Jordanian 

physicians toward 

disclosure of 

cancer 

information, 

comfort and use 

of different 

decision‑making 

approaches, and 

treatment decision 

making. 

Obeidat, R., 

& Khrais, H. 

I. (2016). 

- This study marks a 

point of change in 

public thinking about 

health issues. 

Jordanian public 

preferred to be fully 

informed of their 

cancer diagnosis. 

- They wanted 

information about their 

prognosis, treatment 

and the available 

 

Jordan 

- Quantitative 

Method 

- A descriptive 

cross-sectional 

survey design was 

used. 

-The sample 

consisted of 485 

participants who 

were conveniently 

selected from the 

Jordanian public. 

-To explore 

Jordanian public 

preference on 

cancer diagnosis 

disclosure and the 

type of 

information they 

need. 

Al Qadire, 

M. (2018). 

IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING   (ISSN: 2805-413X)

Volume 4 | Issue 11 | November 2021 |                      http://ijojournals.com/index.php/hsn 10



                                                                                                                                      
                                                                                                                                                                                                        
                                                                                                                                                       

  

supportive services.  

- Most respondents opt 

to disclose the truth; 

however, the vast 

majority of these 

respondents make 

exceptions. 

-Instances of non-

disclosure are 

primarily motivated 

by sociocultural 

constructs. 

Jordan - Quantitative 

Method 

- A descriptive 

cross-sectional 

survey design was 

used 

- The sample 

consisted of 240 

physicians 

from four major 

hospitals in 

Amman, Jordan. 

-To explore the 

truth disclosure 

Practices of 

physicians in 

Jordan, a 

developing 

country. 

Borgan et al. 

(2018) 

 

 

 

IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING   (ISSN: 2805-413X)

Volume 4 | Issue 11 | November 2021 |                      http://ijojournals.com/index.php/hsn 11


	Abstract

