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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

In the precise realm of modern oncology, the histopathologic diagnosis serves as the definitive biological

anchor, initiating a carefully plotted course of treatment (Smith & Jones, 2020). The journey of this diagnosis

from a written report to a patient's understood reality is not a simple translation but a complex act of cultural-

linguistic mediation. Clinicians bear the weight of bridging the technical, Anglo-centric domain of biomedicine

with the lived, experiential world of the patient. While the authors acknowledge that palliative care

encompasses a broad range of serious illnesses beyond oncology, this study focuses specifically on its

application within the context of terminal cancer, where the transition from curative to palliative intent is often

sharply defined.

This mediating function faces its most profound test when the pathology report indicates a terminal prognosis.

Terms like "widely metastatic," "end-stage," or "refractory" signal an immutable pivot in the clinical pathway:

paradigm of "fighting" for a cure to one of "achieving" comfort and peace. While the challenges of breaking

bad news and cross-cultural communication are documented (Bernabe et al., 2022; Norris et al., 2014), there is

a critical gap in understanding the specific linguistic mechanisms used to navigate this transition in African

contexts. How do clinicians linguistically dismantle one reality to co-construct another?

This study therefore asks: What are the dominant linguistic and narrative strategies used by clinicians in

Zimbabwe to negotiate the shift from curative to palliative intent and to discuss end-of-life goals with

Shonaspeaking patients and their families? By answering this question, we seek to illuminate the sophisticated,

often unspoken, communicative work that defines palliative care in a cross-cultural context, moving beyond

identifying barriers to explicating the very tools used to overcome them.

1978/2002, p. 5). Patients are described as "fighting" cancer, undergoing "aggressive" therapy, and either

"winning the battle" or "succumbing" to the disease. This metaphor, while potentially empowering by framing

the patient as an active combatant, carries significant drawbacks. It can imply that survival is a matter of

personal courage and that death is a form of failure, potentially inducing guilt and shame in those whose

disease progresses (Reisfield & Wilson, 2004, p. 424). In response, alternative discourses have emerged within

palliative and supportive care. These include "journey" metaphors, which frame the experience as a path to be

walked with companions, and a focus on "living well" until death, thereby shifting the measure of success from

survival to quality of life and meaning (Kellehear, 2014, p. 45). This body of work establishes that the

metaphorical and narrative framing of terminality is not merely decorative but fundamentally shapes patient

and family understanding, coping mechanisms, and the very experience of illness.

closely tied to Affirming Non-Abandonment, a critical communicative act where clinicians use explicit

language to assure patients and families that they will not be deserted, thus mitigating one of the greatest fears

at the end of life: facing it alone (Wentlandt et al., 2012, p. 1356). This is often realized through phrases like "I

will be with you through this" or "We will continue to care for you here." Furthermore, effective palliative

communication requires Goal Re-alignment, a process of engaging patients in discussions about their priorities

for their remaining life. This necessitates a specific lexicon to discuss symptoms, functional capacity, legacy,

and what constitutes a "good day" (Steinhauser et al., 2000, p. 826). This literature provides a vital framework

for analyzing clinician strategies, shifting the analytical focus from isolated words to the higher-level

conversational objectives that language is employed to achieve.

The concept of a "good death" is not a universal biomedical fact but a deeply cultural construct, varying

(kufa kwakanaka in Shona) is profoundly social and spiritual. It typically involves being surrounded by one's

kin, having one's affairs (both material and social) in order, being at peace with one's ancestors, and leaving

behind a positive legacy for the lineage (Kielmann & Cataldo, 2010, p. 603; Van der Geest, 2004, p. 84).

Conversely, a "bad death" is often one that is sudden, solitary, unanticipated, or the result of witchcraft or

social transgression, leaving the deceased and the family in a state of spiritual peril (Abashem, 2021, p. 21).

Understanding these deep-seated cultural scripts is essential, as they form the interpretive backdrop against

which patients and families hear and make sense of a clinician's words about the end of life. Effective

communication must resonate with, or at least sensitively navigate, these foundational beliefs.

While the literature separately addresses prognosis communication in oncology, discursive strategies in

granular, in-situ linguistic strategies that clinicians naturally develop to cope in the absence of formal

interpretation services. No study has yet systematically documented and analyzed the specific metaphors,

narrative frames, and lexical choices used by clinicians to mediate between the biological fact of terminal

cancer and the cultural ideal of a good death for Shona-speaking patients. This research seeks to fill this critical

gap by empirically investigating the lived discourse practices of clinicians, conceptualizing them not as flawed

interpreters but as skilled culturallinguistic mediators who have developed a pragmatic and nuanced toolkit for

one of medicine's most difficult tasks.

This study employed a qualitative descriptive design, chosen for its suitability in providing a rich, straight

terminal cancer prognoses to Shona-speaking patients. The final sample consisted of 8 participants, including

medical oncologists (2), palliative care doctors (2), palliative care nurses (2), Social Workers (2). Recruitment

continued until thematic saturation was reached.

Data were collected through in-depth, semi-structured interviews conducted in English and Shona. An

"Could you walk me through how you approach a conversation when you know a patient's cancer is no longer

curable?"

"How do you introduce and explain the purpose of palliative care?"

"What words or phrases have you found most effective in these discussions? Can you give examples in Shona

and English?"

"How do you talk about the goals of care when the goal is no longer cure?"

"What are the most important concerns for families, and how does that shape what you say?" Interviews

This represents a pinnacle of cultural-linguistic mediation, where the form of the communication is as

strategically chosen as its content. A poignant example was an oncologist who uses a personally authored poem

Finally, the use of Aesthetic and Narrative Tools (Theme 5) represents a pinnacle of patient-centered, culturally

(Steinhauser et al., 2000) but achieves it through a uniquely indirect and affective channel. Using poetry to

discuss wishes is a profound demonstration of working within, rather than against, cultural norms of

indirectness, transforming a clinical conversation into a shared human experience and powerfully facilitating

the discussion of a "good death."

This study was conducted in an urban setting with clinicians from tertiary institutions; strategies in rural areas

may differ. The data relies on self-reported communication, which may differ from actual practice. Future

research should include direct observation of consultations.

The journey from biologic truth to lived reality is most profound at the end of life. This study has illuminated

can support clinicians in this challenging work. Ultimately, it underscores that in the face of incurable disease,

the goal of communication is to ensure that the final lived reality for the patient and family is not one of

despair and abandonment, but one of supported passage, guided by both clinical compassion and cultural

wisdom, toward a kufa kwakanaka, a good and peaceful death.

We dedicate this work to the memory of our loved ones, whose own battles with cancer are the deeply personal

foundation of this academic inquiry.

Their journeys illuminated the profound chasm that can exist between a diagnosis written in a chart and the

lived experience of the patient and family. In their honour, we sought to understand that space, to study the

words that can either build bridges or deepen divides.