Both Greek and Turkish Cypriot communities, have a strong tradition of family support. When a relative falls ill the family will care for them and has, in the past, always tended to protect their relative from bad news. Until the 1990s, the issue of whether or not a patient knew their diagnosis and prognosis presented difficult ethical dilemmas for those involved in palliative care. However, partly as a result of improvement in cancer survival rates, which reduces the fear of cancer and partly because of more support for the patient and their families there has been a significant shift in attitudes; patients and their families are more willing to speak openly about their illness. As Neophyta Kouppi describes:

‘There are families actually, they need to protect the patient, and they visit the oncologist before and they say “please don’t tell my father his diagnosis, tell everything to me.” You know they want to protect the patient, so they stop the doctor giving information. But if I go back and think about the time we started, till now there are big changes, big steps. Now more patients know about their illness and they know their prognosis and they do things before they die, and they speak more openly.’⁵⁶

Maria-Christina Tchopourian agrees that there have been great changes since 1999 when she started work at the hospice:

‘I’ve seen a change in the way patients speak with their families about this issue. Before it was much more difficult, there was more of an act around this issue. Now I think people are more honest. I think a lot of it has to do with our doctors changing, and informing the patients about their condition, instead of hiding information like they used to. On the other hand, the patients are more ready now to talk about these issues. The families are not always so ready, and at times we work with the families to prepare them to talk with the patient. Ten or 12 years ago, you would rarely hear the word cancer being mentioned, it was always referred to with other names: that’s changing radically. Part of the reason for that is that the doctors are changing; another big part is all the patients that are surviving cancer. Because Cyprus is a small community, these things easily made known: that this person had cancer but is okay now, so people are less afraid.’

Maria-Christina Tchopourian identifies the biggest ethical problem she faces as a professional is how much information a patient has: As she explains:

‘The biggest problem a psychologist faces is when we know more information than the patient, because we really ask the patient to be honest and we are expected to be honest. It really puts us in a difficult position to know more about their illness than they know because they often ask. It’s not a psychologist’s job to inform a patient about their illness or prognosis, but the ethical issue lies in the fact that we work to develop a trusting relationship and it feels unethical to know and act as if we don’t know. Encouraging a more honest relationship between the doctors and patients might solve some of the problem. But, still I think there might be points where the doctor is reluctant to reveal to the patient a poor prognosis, for example. Yet they would openly share it with the multi-disciplinary team. Other members of the team might face the same difficulty, but a trusting relationship might not be so crucial for their job, as it is for a therapeutic relationship between psychologist and patient. A psychologist is expected to really be there.’⁵⁷

The different ways people relate to spiritual attitudes, seem to have influenced and been influenced by more open discussions about death and dying. As Barbara Pitsillides affirms there is a great diversity in beliefs and values of patients and their families.⁵⁸ Neophyta Kouppi comments:

‘We have a priest from the Greek Orthodox church in the hospice. For the other people who come here, like Turkish Cypriots or people from Sri Lanka, Russia or other religions, we always encourage them to bring their own spiritual representative own religion if they want to talk, or to have any kind of service, and we try to give them a single room so they can have their privacy. I think people speak more openly now; even if they don’t believe in any god, there is something more, life after death. They are more open, and they talk more about their family problems, like for example, if they have a child at home which is sick and probably the mother is anxious who is going to take care after her death, or if they feel angry with somebody from the family, then they talk more openly. So people from our multi-disciplinary team can help. We can bring in family members and we can help them find solutions for their anxiety.’⁵⁹