Abstract
Background: Disclosing a cancer diagnosis to patients is believed to facilitate the treatment and care process, ultimately leading to better outcomes.  However, in Ethiopia, disclosure is often delayed or avoided due to a range of complex factors. This study aims to explore the barriers to cancer diagnosis disclosure and the dilemmas that healthcare professionals face in navigating effective disclosure of cancer diagnoses in Ethiopian settings.
Objective: to explore the barriers to cancer diagnosis disclosure and the dilemmas that healthcare professionals face in navigating effective disclosure of cancer diagnoses in Ethiopian settings.
Methods: A qualitative study was conducted in eight hospitals that provide cancer care across four regions of Ethiopia.  In-depth interviews (16), participant observation and informal conversation (3) were conducted with oncologists, gynecologists, surgeons, nurses, general practitioners and caregivers who are routinely involved in cancer care in the respective facilities. Data were transcribed, translated, and managed using NVivo software. An inductive coding approach was applied, followed by thematic framework analysis to interpret the findings.
Result: Despite the legal and ethical implications of cancer diagnosis non-disclosure, our findings revealed that clinicians face significant challenges in disclosing cancer diagnosis. These challenges occur at interpersonal, healthcare professional and systemic levels, including family caregiver influence, fear of negative consequences, professional assumptions, limited experience, and systemic constraints. Fear of negative reactions from patients and caregivers, including emotional distress and potential self-harm, leads professionals to hesitation. Caregivers also prevent full disclosure to protect patients from perceived negative outcomes. The experience of healthcare providers, particularly junior residents, can be hindered by a lack of knowledge about the details of therapeutic options or effective communication skills. The disclosure process is further hindered by patient characteristics, such as age, cancer stage, and socioeconomic status, as professionals weigh the potential emotional and financial impact of the diagnosis and treatment options, collectively putting professionals in a dilemma while disclosing cancer diagnoses.
Conclusion: Several factors make disclosing cancer diagnoses difficult for clinicians. Fear of negative consequences, caregiver influence, provider skill gaps, and patient circumstances hinder disclosure, creating an ethical dilemma among professionals. Healthcare institutions should therefore provide communication training, establish clear disclosure guidelines, and offer emotional support to clinicians. Disclosure must respect patient autonomy and be adapted to cultural and emotional contexts to ensure compassionate care.

A roadmap of themes, subthemes and codes