The Effects of Peer Education on Treatment Adherence among Patients Receiving Hemodialysis: A Randomized Controlled Trial.

Background: Non-adherence to treatments increases the rates of hemodialysis complications, hospitalization, and mortality. One strategy for adherence improvement is peer education. This study aimed to investigate the effects of peer education on treatment adherence among patients receiving hemodialysis. Materials and Methods: This was a randomized controlled trial. Patients in the control group were provided just with routine care, and the intervention group received peer education. Treatment adherence was assessed both before and after the intervention via the End-Stage Renal Disease (ESRD) Adherence Questionnaire. Data analysis was conducted by the Chi-square, the Mann-Whitney U, the paired-sample t, and the independent-sample t tests. Results: There were no significant between-group differences in terms of the pre-test mean scores of Adherence to regular attendance at hemodialysis sessions (t = 0.19, p = 0.85), Adherence to the prescribed medications (t = 0.46, p = 0.64), and Adherence to fluid restrictions (t = 0.24, p = 0.81). The same finding was observed after the intervention, except for the mean score of the adherence to fluid restrictions dimension which was significantly greater in the intervention group (t = 2.86, p = 0.006). Moreover, no significant changes were observed in the mean scores of treatment adherence dimensions in the control group. However, in the intervention group, the mean scores of the adherence to regular attendance at hemodialysis sessions (t = 3.79, p < 0.001) and the adherence to fluid restrictions dimensions were significantly greater than their pre-test values (t = 4.47, p < 0.001). Conclusions: Education by peer groups improves the compliance of patients with regard to the consumption of fluids in the interval between two dialysis sessions.

The Effect of Home Care on Metabolic Profile and Blood Pressure in Type 2 Diabetic Patients who Underwent General Surgeries.

Background: The stress of surgery itself results in metabolic disturbance. Few studies have mentioned how to manage the metabolic profile of diabetic patients after discharge from the hospital. The present study aimed to determine the effect of home care on metabolic profile and blood pressure in type 2 diabetic patients who underwent general surgeries. Methods: Seventy type 2 diabetic patients who were undergoing surgery were assigned to the intervention and control groups via blocking order. The intervention group received a 3-month home care with an interprofessional team approach. The levels of fasting blood glucose, glycosylated hemoglobin (HbA1c), total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterols, systolic blood pressure, and diastolic blood pressure were measured before and three months after the intervention in both groups. In the control group, only routine care was performed in the postsurgery period. Data were entered in SPSS software version 23 and were analyzed. Results: There were no significant differences between the intervention and control groups for background characteristics. Systolic blood pressure (P < .001), diastolic blood pressure (P = 0.005), lipid profile (P = 0.001) [except for triglycerides level], fasting blood glucose (P = .001), and HbA1c (P = .003) decreased significantly in the intervention group. After controlling baseline data by applying analysis of covariance, a significant increase in HDL-c (P = .032) was seen. Also, the difference between the mean percentage of variations in HbA1c levels between intervention and control groups was significant. Conclusions: Our study showed improvement in HbA1c and HDL-c levels with home care programs in patients with diabetes who underwent general surgeries. More studies with longer follow-ups are necessarily addressing the effects of home care on other metabolic parameters in these patients.

Is Web-Based Program Effective on Self-Care Behaviors and Glycated Hemoglobin in Patients with Type 2 Diabetes: A Randomized Controlled Trial.

Background: Diabetes Self-Management Education and Support (DSMES) as a framework focuses on seven self-care behaviors. Moreover, technology-assisted self-care education is increasingly suggested for patients with Type 2 Diabetes Mellitus (T2DM). Therefore, we examined the effect of a web-based program on self-care behaviors and glycated hemoglobin values in patients with diabetes mellitus. Materials and Methods: This randomized controlled clinical trial was conducted at Alzahra Hospital in Isfahan, Iran, between April and November 2020 and included 70 patients with T2DM. Data were collected using a questionnaire that included a demographic information section and a diabetes self-management section with 21 questions on a Likert scale. Fasting blood samples (2.50 ml) were collected before and after the interventions to measure HbA1c levels. The study intervention involved a web-based program that included multimedia educational content (such as videos, lectures, educational motion graphics, text files, posters, and podcasts) presented in seven sections based on DSMES over a 21-day period with monitoring by an instructor. Results: The mean scores for healthy eating (F = 3.48, p = 0.034) and medication adherence (F = 6.70, p < 0.001) significantly increased in the interventional group, while the mean scores for being active, monitoring, reducing risks, problem-solving, and healthy coping did not significantly change. Additionally, the mean differences in HbA1c values significantly improved in the interventional group compared to the control (F = 5,1, p = 0.026). Conclusions: A web-based program in accordance with DSMES improved HbA1c levels and increased scores for healthy eating and medication adherence in patients with T2DM. However, further research with larger sample sizes and qualitative interviews is needed.

Lived Experiences of Diabetes Team and Patients about Diabetes Care System after Redesigning Delivery System and Supporting Self-Management in Iran: A Qualitative Research.

Background: Diabetes as a chronic disease requires a change in the paradigm of treatment and health care system based on acute illnesses to chronic conditions. Chronic Care Model has been designed to address this need. This study aimed to explore the lived experiences of the diabetes team and diabetic patients regarding the health care system after redesigning delivery system and supporting self-management based on the Chronic Care Model in Iran. Methods: Research was conducted with a qualitative descriptive approach in one of the Isfahan city clinics in 2018. The participants were diabetes team (composed of diabetes physician, nurse, assistant nurse and dean of the clinic) and 17 type- 2 diabetic patients who were selected through purposive sampling. Data collection was performed through semi-structured interviews and then were analyzed using content analysis with an inductive approach. Results: The findings of this study were composed of the following two main categories: (1) educational function change, including the sub-categories of evidence-based nurse education and patients' demand to ongoing participation in the training classes; and (2) treatment and care method upgrade, including the sub-categories of nurse's role change in a team approach, continuity in cares and upgrading patients' self-care behaviors. Conclusions: Delivery system redesign and diabetes self-management support based on Chronic Care Model changed organizational structure and performance of the diabetes care system. It also reformed the structure of treatment providers from a vertical and hierarchical form to a team arrangement. Nurse's educational function became evidence-based and patients' self-care behaviors upgraded.

The most prominent problems of diabetes education in Iran: A qualitative content analysis.

BACKGROUND: Education in vulnerable communities can be a health affordable strategy to promote patient empowerment. Recognition and understanding the problems of diabetes education are of significance to overcome the barriers and advance the educational and care services to control diabetes and promotion of society health. The aim of this study was to explore participants' perspectives, experiences, and preferences, regarding diabetes education problems. MATERIALS AND METHODS: This descriptive, qualitative study was conducted from March 2016 to September 2017. The participants were 23 people including nine patients with diabetes and their family members and 14 members of diabetes healthcare team (physicians, nurses, and nutritionists). The data were collected through individual semi-structured interviews and analyzed through conventional content analysis approach proposed by Graneheim and Lundman. Some main categories and subcategories emerged. RESULTS: Three main categories showed the most prominent problems of diabetes education, namely, inadequate infrastructure for diabetes education, insufficient defined and de facto position for the role of diabetes nurse educator, and the failure in patient-oriented team approach in diabetes education. CONCLUSION: This article addresses the most important problems of diabetes education. The fundamental strategy to overcome these problems seems to be the planning and management of diabetes education as a high priority in the noncommunicable disease management policies of the Ministry of Health and Medical Education.

The components of diabetes educator's competence in diabetes self-management education in Iran: A qualitative study.

BACKGROUND: Limited research has been conducted in the field of diabetes educator's competency. However, no comprehensive and integrated explanations of educator's competence requirements in treatment centers exist in Iran. The aim of this study is to explain the components of diabetes educator's competence in diabetes self-management education in Iran. MATERIALS AND METHODS: This was a qualitative descriptive-exploratory study. The data were collected through semi-structured and in-depth interviews and using purposeful sampling method in Isfahan University of medical science from April to October 2018. Sampling continued until data saturation. Participants included 20 people who were selected by purposive and snowball sampling method. The interviews were analyzed using content analysis method of Graneheim, Lundman. RESULTS: Data analysis resulted in the emergence of three main categories including (1) Patient and family centered education, (2) process-based education, and (3) continuous progress in profession and also seven subcategories (patient and family activation, empower), facilitating educational process, comprehensive education assessment, development, implementation and evaluation of educational plans, developing educators' educational knowledge and skills, development of creativity and innovation, promote inter-professional cooperation in education. CONCLUSION: The evaluation of facilitation factors for participation and empowerment patient and family along with creativity and interprofessional collaboration for comprehensive evaluation of patients in designing, implementation of educational programs were mentioned as important competencies of diabetes educators, which can have a significant impact on patients' recovery, treatment, and the promotion of society's health.

Restrictors of the effectiveness of diabetes self-management education: A qualitative content analysis.

BACKGROUND: A key step for improving the effectiveness of diabetes self-management education (DSME) is to identify its restrictors. OBJECTIVES: The aim of this study was to explore the restrictors of the effectiveness of DSME. METHODS: This descriptive qualitative study was conducted in March 2016-2017. Participants were 16 DSME providers (viz., physicians, nurses, nutritionists, and psychologists) and nine DSME receivers (viz., patients and their family members) - 25 in total. Semi-structured interviews were held for data collection. Interviews were transcribed word by word and analyzed through conventional content analysis approach proposed by Graneheim and Lundman. RESULTS: The restrictors of the effectiveness of DSME were categorized into three main categories and 11 subcategories, namely patients' limited welcoming of DSME classes (allocating limited time for participation in DSME classes, inadequate knowledge about diabetes mellitus [DM] importance, inappropriate educational environment, and financial problems), unfavorable adherence to treatments: serious challenge (inattention to educations, poor motivation for adherence to medical recommendations, and inattention to the psychological aspects of DM), and the difficulty of adult education (the difficulty of changing health-related attitudes and behaviors, mere information delivery during education, adults' physical and perceptual limitations, and diabetes educators' limited competence in adult education). CONCLUSION: The findings of the present study provide an in-depth understanding about the restrictors of the effectiveness of DSME. DM management authorities and policymakers can use these findings to develop strategies for improving the effectiveness of DSME.

The effect of home care on readmission and mortality rate in patients with diabetes who underwent general surgeries.

BACKGROUND: More than one-half of people with diabetes need at least one surgery in their lifespan. Few studies have addressed how to manage the needs of these patients after discharge from the hospital. The present study is designed to determine the effect of home care on readmission of Type 2 diabetic patients who underwent surgical procedures. MATERIALS AND METHODS: The present study was a randomized clinical trial. Sixty-nine patients with Type 2 diabetes undergoing surgery were assigned to the intervention and control groups via blocking order in the selected educational hospitals of Isfahan 2019. Home care was performed for 3 months with interprofessional team approach. Data collection tools were re-admission checklist. Data were entered in SPSS software version 23 and were analyzed by nonparametric tests. RESULTS: The background characteristics in the intervention and control groups were not different. The frequency of readmission in the control and intervention groups from the time of discharge until 3 months later was 25.7% and 18.9%, respectively. Frequency of readmission in the intervention and control groups was not significant in 3 months from discharge, P > 0.05. The mortality rate was 11.4% and 0% in control and intervention groups, respectively, P < 0.05. CONCLUSION: It can be argued that continued home care can decrease the rate of readmission and mortality rate in patients with Type 2 diabetes who will discharge from surgical wards.

Challenges and Strategies of Needs Assessment Implementing in Diabetes Self-management Education in Iran: A Qualitative Study.

BACKGROUND: Many diabetes educators in Iran do not have the necessary skills and competence for performing a needs assessment, and thus, cannot provide Diabetes Self-Management Education (DSME) to suit individual educational needs and conditions. The purpose of the present study was to explore and analyze needs assessment implementation in DSME and evaluate the barriers and the appropriate strategies from educators' viewpoints. MATERIALS AND METHODS: The present qualitative study was conducted using a conventional content analysis approach with semi-structured and in-depth interviews and using a purposeful sampling method on 20 nurses, physicians, and endocrinologists. The data of this study were collected from April to October 2018. The interviews were analyzed using the content analysis method of Graneheim and Lundman. RESULTS: Qualitative data analysis resulted in the emergence of two main categories of educational challenges of needs assessment and managerial challenges of needs assessment and four subcategories (lack of structured educational planning, lack of needs assessment practical patterns, managers' insufficient support and supervision, and managers' insufficient attention to motivational factors). CONCLUSIONS: Educational strategic planning, managers' obligation and support in designing practical patterns, and supervision tools to evaluate educators' performance in the needs assessment domain can result in the promotion of DSME needs assessment, the efficiency of plans, and the promotion of society's health.

Diabetes management challenges in Iran: A qualitative content analysis.

AIM: To explore and analyse diabetes management challenges in the patients visiting a diabetes unit in Iran. BACKGROUND: Managing a chronic disease like diabetes needs the patients' follow-up and coherent care delivery system. In fact, it requires a systematic and organised care delivery system with skilful and specialist team. METHODS: This qualitative research was conducted at a specialized poly-clinic of Isfahan insurance organisation in 2016. The research participants were the members of clinic diabetes unit (physician, nurse, secretary, clinic director) and 21 type 2 diabetic patients of the clinic who were selected using purposeful sampling method. Data were collected by semi-structured interviews and analysed using content analysis. RESULTS: The qualitative findings of this research were obtained in two main categories including the following: (a) weak care delivery system and (b) defective diabetes self-care. CONCLUSIONS: The results of this research have demonstrated that there are system-centred and patient-centred challenges in diabetes management, and they can affect the patients' health outcomes. IMPLICATIONS FOR NURSING MANAGEMENT: Since diabetes is one of the health system priorities, the findings of this study can be a warning for managers and policy makers to plan seriously to reform diabetes management system infrastructures.

Overcoming Challenges of Implementing Chronic Care Model in Diabetes Management: An Action Research Approach.

BACKGROUND: Reforming the health care system to improve suitable health care model for diabetic patients is essential. This study aimed to implement, identify, and overcome the challenges of implementing the Chronic Care Model in diabetes management in a clinic. METHODS: This study is a qualitative technical action research with the Kemmis and McTaggart model including planning, action, reflection, observation, and revision plan which was conducted in the specialized polyclinic from 2015 to 2017 in Isfahan city - Iran. Data were gathered through qualitative and quantitative methods. Diabetes team and 17 patients with type 2 diabetes participated in semi-structured interviews that were purposively chosen. Qualitative data were analyzed using content analysis and then quantitative data collected. RESULTS: The qualitative findings of this research are in five main categories: System design upgrade, self-management upgrade, decision support, health care organization, and clinical information system upgrade. Results of quantitative data showed that most metabolic indicators like HbA1c have statistical meaningful changes (P value < 0.05). CONCLUSIONS: Implementing the Chronic Care Model became feasible despite serious challenges and two groups of ready and active team and active patients were developed. The study showed that one important lost link of diabetes management is underestimating the nurses' capabilities in the management of this disease. Inevitably, serious investment on maximum use of nurses' knowledge and skills in improving diabetes management will help diabetes care upgrade significantly.

Triggers for reflection in undergraduate clinical nursing education: A qualitative descriptive study.

BACKGROUND: Reflection is a key component of effective teaching in baccalaureate nursing education. However, there are limited empirical studies into the factors which trigger reflection in undergraduate clinical nursing education. OBJECTIVES: This study aimed to explore reflection triggers in undergraduate clinical nursing education with a specific focus on verbalized reflection in spoken dialogues. METHODS: This qualitative descriptive study was conducted in 2017-2018. Participants were seventeen clinical nursing instructors, 32 nursing students, and nine newly graduated nurses who were purposively recruited from four universities and two hospitals in Iran. Data were collected via 26 in-depth semi-structured face-to-face interviews with clinical nursing instructors and newly graduated nurses and four focus group discussions with students. Conventional content analysis was used for data analysis. RESULTS: Reflection triggers fell into the following four main categories: conscious comparison of actions, confrontation with influential realities, emotional and moral involvement in patient care, and demanding accountability. CONCLUSION: This study suggests triggers for reflection in clinical nursing education. Instructors' use of reflection triggers can help students reflect on their actions and practice.

Improving Quality of Care in Hemodialysis: a Content Analysis.

Introduction: Hemodialysis is currently the most common alternative treatment in patients with renal failure in the world. Today, despite the support provided by healthcare providers for these patients, they still express dissatisfaction with the quality of care and find it inadequate. However, there have been few studies investigating the needs of in-patients receiving hemodialysis care in Iran. Thus this research was undertaken to study the needs and demands of such patients. Methods: This qualitative research was conducted from June to November 2016 to investigate the view points of the patients, their families and health care providers about improving quality of care in dialysis unit. At first, the sampling was based on a purposeful sampling method. A total of 35 participants (patients, their families and health care providers) were interviewed. The interviews were analyzed via Graneheim & Lundman qualitative content analysis. Results: Data analyses led to the production of 700 primary codes, 54 subcategories and 27 secondary categories out which 4 main categories of modification of physical stressors, requirement of support and the requirement of improved quality of Health Care service and improved facilities and equipment requirement. Conclusion: Planning for modification of physical stressors, improved support of patients, enhancing the quality of care services provided by the treatment team, upgrading the facilities and equipment and the adoption of an interdisciplinary approach are all believed to improve the care services among in-patients receiving hemodialysis treatment.

Status of observance of structural standards in rehabilitation centers and nursing homes.

INTRODUCTION: The purpose of this study was to determine the status of observance of structural standards in rehabilitation centers and nursing homes. MATERIALS AND METHODS: This cross-sectional descriptive study was carried out on 12 centers of the nursing homes of Isfahan city during 2016-2017. The tool was a check. To complete the checklist, the direct observation of the environment and the review of existing documents were used. Data were analyzed by descriptive statistics and frequency distribution. RESULTS: The findings of this study shows that of 11 standards ofworkforce standards regarding to health expert presence, nurse presence, therapist and extracurricular instructor presence, have been observed innone of the centers, and the presence of social worker/psychologist in 50% of the centers. Of the 21 standards relating to the physical environment, eight standards have not been met in any of the centers. Of the 25 standards relating to the general conditions of building, 4 standards have not been met in any of the centers. Of the 10 standard relating to the equipment and supplies which are needed, 3 were not observed in any of the centers. Of the 10 standards relating to the required services, except one, standards have been met in all centers. Of the 10 standards relating to the general provisions, 7 are met in all centers of both types. CONCLUSION: According to the findings, a significant percentage of standards have not been met in any of the aging centers or just met in some of these centers. It is hoped that the results of this study will enable authorities to promote standardization of nursing homes and rehabilitation centers.

The Effect of Spiritual Care on the Body Image of Patients Undergoing Amputation due to Type 2 Diabetes: A Randomized Clinical Trial.

BACKGROUND: Body image, as an important factor in quality of life (QOL) satisfaction, in amputee patients is strongly affected by amputation, which can put the patient at risk of psychological disorders such as depression. Hence, this study was conducted to investigate the effect of spiritual care on body image in patients with type 2 diabetes-related amputation. MATERIALS AND METHODS: In this study, an experimental pretest-posttest design with two groups was used. A total of 54 participants (Males = 41, Females = 13) aged between 40 and 72 who had diabetes-related amputation participated in the study. The participants were randomly assigned to the meditation and control group. For the experimental group, three sessions of meditation, and for control group, three sessions regarding prevention of diabetic foot ulcer were conducted. The participants in the experimental group were asked to perform meditation exercises for a month. The data was collected via Amputee Body Image Scale before and 4 weeks after the intervention. RESULTS: There were no significant differences between groups on demographic variables. After intervention, the meditation group showed lower levels of body image disturbance compared with the control group, which was significant (t=3.41, p = 0.001). CONCLUSIONS: It can be concluded that meditation can improve body image in patients with diabetes-related amputation. In addition, because of no side effects and high acceptance of spiritual care, this method can be used as a way to improve the condition of patients.

Nursing students' viewpoints toward two methods of clinical conference and clinical nursing round.

BACKGROUND: Clinical education provides a chance to combine theoretical knowledge and clinical skills. Students are the key elements in the evaluation of clinical education efficacy. The present study was aimed to define nursing students' viewpoints concerning conformity to the characteristics of clinical conference and clinical round. METHODS: This descriptive analytical study was conducted on the bachelor's students of the 4th-6th semester of nursing. Sampling was conducted using census sampling method during the 2nd semester of 2014-2015 school year. Data collection tool was a three-section researcher-made questionnaire containing demographic, nursing round, and clinical conference characteristics. Descriptive and inferential statistical tests (independent t-test, ANOVA, and Spearman and Pearson correlation coefficients) were used for data analysis. RESULTS: Participants were 134 bachelor's students of the 4th-6th semester of nursing. According to half of the participants, conformity to the characteristics of clinical conference (45.5%, 53%) and clinical round (44%, 51.5%) were poor and medium, respectively. Paired t-test showed a significant difference between students' viewpoints toward the planning of clinical conference and clinical nursing round (P = 0.006, t = 2.77). CONCLUSIONS: According to the results of the present study on students' viewpoints, clinical education faces a serious challenge with regard to clinical education methods. Considering the necessity and importance of clinical education, more investigation should be conducted to detect its relevant factors and plan for its improvement.

Nurses' experiences from pain management in children in Iranian culture: A phenomenology study.

BACKGROUND: Management pain in hospitalized children is challenging for the health-care professionals. Nurses have the most interactions with children who need to assess and manage for their pain. Therefore, the aim was to describe nurses' experiences from pain management among hospitalized children from Iranian culture in this study. METHODS: A phenomenological study was conducted in which 23 nurses working in an educational hospital in Isfahan-Iran. The nurses participated in interviews based on a purposeful sampling method. RESULTS: Participants' experiences were categorized into three major themes and twelve subthemes including the nurses' ability of detection of the pain nature, reaction to pain management and belief in pain relief. CONCLUSIONS: The research showed that the nurses have valuable experiences in pain management in their workplaces. Their descriptions were based on the use of three domains that consist of knowledge, belief, and practice. Therefore, it is vital to focus on the subject of pain in nursing curriculum and guidelines in hospitals. A more extensive research is needed to demonstrate perceived barriers to pain management.

How much elderly people of Isfahan are adherent to their drug therapy regimens?

BACKGROUND: The need for a correct follow-up for medical advices of health givers is the cornerstone for avoiding drug-related complications in especial period of elderly people life. There isn't any data about drug therapy regimens adherence of elderly people of Isfahan. In this study, we aimed to cover this deficit. MATERIALS AND METHODS: In this cross-sectional study which was carried out in Isfahan (Iran) in 2013 senior citizens (aged 65 or more) who were taking at least one medication and had no record of residency in nursing homes were included. We used Morisky medication adherence scale (after validation and reliability assessment for using this questionnaire in Persian language) to evaluate the level of adherence in the study population. RESULTS: A total of 200 elderly participants were fully studied (n = 200, 61% females), and 52% of them had poor medication adherence. 77.5% of participants were suffered from at least four medical illnesses, and 18.5% of them were taking more than eight medications per day. We have not found any significant statistical relationship between vision or hearing loss disorders and the medication adherence of the participants). There was a significant positive relationship between the level of education and medication adherence (P = 0.001), (χ2 = 0.29). CONCLUSION: Low Medication adherence is a common and important drug issue in the elderly in Isfahan. This issue can lead to medical complications and huge cost if it is not addressed appropriately.

Breaking bad news protocol for cancer disclosure: an Iranian version.

In Iran, as in many Asian and Middle Eastern countries, a significant proportion of cancer patients are never informed of their illness. One solution that has been proposed to tackle this challenge is to develop a localized protocol on cancer diagnosis disclosure based on the culture and values of community members, and train healthcare team members to deliver the bad news using this protocol. This article introduces a localized protocol for disclosure of bad news to cancer patients in Iran. This protocol consists of six steps, including assessment, planning, preparation, disclosure, support and conclusion. In the drafting of this protocol an attempt was made to meticulously consider the cultural features of the Iranian society. Although breaking bad news will never be easy, having an appropriate plan of action based on individual's attitudes, considerably helps health-care professionals, and provides more satisfaction in patients.

Perceptions of patients, families, physicians and nurses regarding challenges in cancer disclosure: A descriptive qualitative study.

PURPOSE: The findings of numerous studies have illustrated that there is still a high proportion of cancer patients in Eastern and Middle-East countries including Iran, who are not properly informed of their disease due to the concealment atmosphere which still prevails. This descriptive qualitative study is aimed at exploring perceptions of patients, patients' family members, physicians and nurses regarding cancer disclosure challenges. METHODS: Thirty-five participants (15 patients, 6 family members, 9 physicians, and 5 nurses) were selected through purposive sampling. The data were collected through in-depth interviews; after which they were analyzed using a qualitative content analysis with an inductive approach. RESULTS: Data analysis revealed the following three categories: first, challenges related to healthcare system which deals with the deficiencies, strains and concerns in medical setting and healthcare team training; second, challenges related to family insistence on concealment which includes their fear of cancer disclosure and its negative impact on the patients; and third, challenges related to policy making which consists of deficiencies in legislative and supportive institutions for advocacy of truth telling. CONCLUSIONS: Successful move from concealment to effective disclosure attitude in cancer patients in Iran requires a national determination for resolving challenges in medical education as well as other different social, cultural and policy making dimensions.