Navigating the Final Path: Linguistic Strategies for Mediating Terminal Prognosis and End-of-Life Goals in Shona Oncology Care

This study investigates the linguistic strategies employed by clinicians in Zimbabwe to mediate the communication of a terminal cancer prognosis and end-of-life care goals for Shona-speaking patients. In this cross-cultural setting, where biomedical practice operates in English and patients' lived experiences are framed in Shona, clinicians face the critical task of navigating the transition from curative to palliative intent. Using a qualitative descriptive design, we conducted in-depth, semi-structured interviews with a purposive sample of oncologists, palliative care specialists, and Social Workers in Harare. Data were analyzed using reflexive thematic analysis to identify recurring communicative patterns. Our findings reveal a repertoire of sophisticated strategies clinicians use to negotiate this sensitive interface, which include the strategic re-framing of therapeutic goals from a "battle" to a "journey," the careful selection of lexicon to discuss death and comfort, and relational positioning that affirms non-abandonment and incorporates the family. This research demonstrates that clinicians act as essential cultural-linguistic mediators who develop a nuanced discursive toolkit to bridge biomedical reality and patient values. Documenting these strategies is a vital step toward developing culturally-competent models of communication that aim to ensure the end of life is guided as much by cultural resonance as by clinical evidence, thereby honoring the profound journey from biologic truth to a dignified lived reality.

End-of-Life Communication, Palliative Care, Cultural Linguistics, Shona

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