Culturally competent patient–provider communication with Zulu patients diagnosed with osteosarcoma: an evidence-based practice guideline



evidence-based practice guideline, cancer, osteosarcoma, cultural competence, patient–provider communication, cross-cultural clinical settings


This guideline was developed as a response to patients with osteosarcoma presenting late for treatment thereby significantly affecting their prognoses. Healthcare providers recognised the role of culture and the importance of culturally competent communication in addressing this problem.

The aim of this guideline is to present healthcare providers treating Zulu patients diagnosed with osteosarcoma with evidence-based recommendations that can facilitate culturally competent communication regarding the diagnosis, treatment and prognosis of osteosarcoma.

The AGREE II (Appraisal of Guidelines, Research and Evaluation) appraisal instrument was used as a guide for developing the evidence-based practice guideline. An integrative literature review, focus groups with healthcare providers, and in depth interviews with Zulu patients were conducted to gather the evidence for the evidence-based practice guideline. The guideline was reviewed by four content and methodological experts using the AGREE II tool.

The guideline specifies generic aspects such as the awareness, knowledge, skills and provider attitudes required for culturally competent communication as well as the type of healthcare system that can support and cultivate such communication. Specific recommendations for communicating the diagnosis, treatment and prognosis of osteosarcoma to Zulu patients were also included.

Healthcare providers will require cultural competence and communication training in order to facilitate the implementation of the guideline. Some of the challenges identified in the focus group interviews are not addressed in this guideline, leaving room for further development of the guideline. Evidence-based practice can contribute to improving culturally competent communication with cancer patients receiving treatment at culturally discordant healthcare facilities.

Level of evidence: Level 5

Author Biographies

Ottilia Brown, University of KwaZulu-Natal

School of Clinical Medicine, University of KwaZulu-Natal, Durban, South A

Dalena RM Van Rooyen, Nelson Mandela University

School of Clinical Care Sciences, Nelson Mandela University, Port Elizabeth, South Africa

Colleen Aldous, University of KwaZulu-Natal

School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa

Leonard C Marais, University of KwaZulu-Natal

Department of Orthopaedic Surgery, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa






Orthopaedic Oncology and Infections

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