COMMENTARY Commentary on Kendall S (2006) Being asked not to tell: nurses’ experiences of caring for cancer patients not told their diagnosis. Journal of Clinical Nursing 15, 1149–1157 Eleanor A Holroyd PhD, RN Associate Professor, Nethersole School of Nursing, Chinese University of Hong Kong, Hong Kong SAR, China This paper (Kendall 2006) presents an important and under researched area in which culture, religion, moral philosophy, Chinese medicine, modernity and western-based ethics col- lide. The paper also begs the question of the complexity of lay and professional communications in respect to the decision to tell or not to tell the truth regarding the diagnosis of cancer for Chinese patients. With respect to Chinese society, issues of death taboo, family harmony, cancer as contagious, deference to authority and non-verbal communication patterns sit at the heart of this debate. Many Chinese families object to nurses and doctors telling an unfavourable diagnosis and prognosis directly to their family member. This paper focuses on the difficulties nurses encounter when caring for Chinese patients who have not been informed of their diagnosis. While the aim intends to investi- gate a highly needed and under researched area, I would argue that the paper needs to be situated in a more in-depth Chinese analysis. While a Chinese context is alluded to in the introduction, much more use needs to have been made of the Chinese anthropological and philosophical essays that take into account the core issues at stake here. Little recourse is made to ‘Chineseness’ in relevance to history to clinical service. For Registered Nurses who are ethnically Chinese and work in the medical systems of Hong Kong, the conflict is between personal beliefs systems and immersion in bio-medical edu- cation in which a western ethical system is paramount. The clash between these worlds has not been summarized in this paper yet is evident in the testimonies produced. Many cultures perceive disclosure of impending death and, in particular, cancer as a harmful act. Doctors in Mainland, China often inform the family members of such a prognosis instead of the patient (Li & Chou 1997, Pang 1999). In Hong Kong only 68% of patients had been fully informed accord- ing to recent research (Fielding et al. 1995) and in the case of cancer 70% of patients had none or incomplete disclosure. The paper would have further benefited from more com- parative literature on the rates and experience of disclosure of bad news in Chinese, other Asian and non-Asian societies. Disclosure rates of cancer diagnosis range across cultures from a low of 24% in Greece to a high of 89% in Finland, averaging around 50% (Fielding et al. 1995). A study of terminally ill patients’ experiences of nursing support in Australia indicated that, while patients wanted the nurse to tell them if their condition had deteriorated, they also did not like the nurses talking directly to them about death and dying. What is suggested is that, while this paper was situated in Chinese society, the responses were not uniquely Chinese. What is also inferred is a worldwide response to modernity and professional accountability rather than merely issues of medical disclosure. The paper, however, needed to argue for how this response may be in opposition to Chinese belief systems designed to provide protection from fate in which ‘family determination’ and ‘death as taboo’ needs considera- tion (Tse et al. 2003). For example, recent sociological studies in Mainland China, conducted after the post Maosit era, show that, despite the death taboos, more older people are openly preparing for their funeral before their death by getting coffins, photos and ‘death’ clothing ready. What is suggested is a change in willingness to acknowledge death in both Chinese and other societies, this literature needs further examination. China’s multitude of pluralistic religions including Daoism, Buddhism and arguably Confucianism loosely informs the meaning and communication of death. In contemporary Hong Kong, cliche ´d phrases are popularly used that depict common elements of life death in a harmonious continuum, death as a preservation of virtue (Confucianism), belief in new life after death or nirvana (Buddhism), death as part of the process of the wheel of rebirth, and that death is both to be at peace and to be feared. Correspondence: Eleanor A Holroyd, Associate Professor, Nethersole School of Nursing, Chinese University of Hong Kong, Shaton NT, Hong Kong SAR, China. E-mail: eholroyd@cuhk.edu.hk 2370 Ó 2007 The Author. Journal compilation Ó 2007 Blackwell Publishing Ltd doi: 10.1111/j.1365-2702.2006.01676.x