African Americans continue to experience the highest overall cancer mortality rates, more advanced staged cancers [2], and higher levels of psychological distress from cancer than non-Hispanic Whites [1]. African American patients and family members often attribute the root cause of their psychological distress to overwhelming anxieties and concerns that cancer will lead to suffering, death, and isolation for their family member diagnosed with cancer.
Older African Americans, in particular, have transmitted stories of “making it through” times of oppression and serious illness that incorporate their strong religious culture [5, 19]. Historically, stories communicated through religious songs that have memorized and transmitted orally was a strategy that has given African Americans deep meaning to their human existence [20]. Stories told through religious songs has also been a cultural strategy by which the African American slave communicated their fears to God and also a strategy to communicate encouragement to one another in their plight [19]. The spirituals, for example, permitted African slaves to maintain a positive sense of self (through a self-identity as a child of God), to cope with a life in servitude, and to express their belief in the promise of a future life that would be free of pain and suffering [5, 19].
African Americans have also incorporated Biblical text into their stories. Similar to religious songs, memorized biblical text was also used among the African American slave to express their belief systems as well as their perceived connectedness to God and to other individuals who were suffering and powerless [5, 19].
For example, biblical text frequently memorized and transmitted intergenerationally among African Americans to encourage individuals during adversity have frequently included stories where God led the Israelites from Egyptian bondage, Daniel delivered from the lions’ den, the Hebrew children’s escape from the fiery furnace, and Joshua’s conquest with the Battle of Jericho [5]. These stories grounded in biblical text were used among the African American slaves to communicate their existence as human beings and to express their belief in God’s promise of deliverance from their suffering [5].
Currently, stories grounded in the strong religious and spiritual culture of African Americans continue to be a significant strategy to manage stressful life events among African Americans when confronting life-threatening illnesses such as cancer. During stressful situations such as uncertainties during treatment, unsupportive social interactions, and fears of recurrence, stories communicated via religious songs are sources of comfort and strength, enabling individuals to persevere and remain optimistic [8]. Supportive messages transmitted via religious songs and biblical text to overcome psychological distress are commonly and notably interwoven into the culture of African Americans [12, 19]. And, just as with their ancestors of African Americans, stories are used to share the belief of a sacred being who has the ability to protect, heal, and deliver them from the evils and sufferings of their worldly existence [5]. Moreover, stories are used to encourage a positive sense of self, to express a belief and faith in overcoming stressful life situations [5, 20], and to promote social relationships among naturally occurring family networks [9]. Despite this strong cultural heritage of storytelling through religious song narrative and impact on health and well-being, researchers and educators have yet to fully embrace and incorporate this meaningful strategy into the supportive care of African American cancer patients and their family members.
Interventions that are grounded in storytelling are emerging as a beneficial method for improving health outcomes among racial/ethnic minority groups as well as those with cancer [11, 13, 16]. Additionally, populations with low literacy skills who may prefer methods of orality to gain and/or regain their voices due to difficult circumstances may find storytelling beneficial [15]. In research among African American adult populations, storytelling interventions have resulted in increased health-promoting behaviors such as adherence to follow-up care and quality of life among breast cancer patients [6], increasing self-care among diabetic patients [7], and improvements to blood pressure [10]. In a review of these storytelling interventions, the content generally focuses on information for self-management of diabetes [21], for controlling high blood pressure [3, 10, 17], and cessation of smoking [4]. Culturally relevant storytelling interventions have also been designed to promote cancer screening and incorporated spirituality; however, whether these stories have incorporated religious songs and biblical text is not clear [18]. Storytelling interventions that incorporate culture, specifically dimensions of spirituality as simply as an add-on to other content for health promotion may not have lasting effects [14].
The incorporation of stories along with religious songs and biblical text might be of benefit to African American cancer populations and their family members in several ways. In terms of cancer education implications, healthcare practitioners might encourage the cancer patient to talk about their favorite religious song or biblical text and spiritual ways of coping during health assessments as a way to initiate conversations related to psychological distress levels. Secondly, healthcare practitioners might encourage the African American cancer patient experiencing high levels of psychological distress to recall a favorite religious song or biblical text and discuss with them ways in which the song or text might be a coping strategy and source of hope, comfort, and encouragement. Finally, healthcare practitioners might incorporate the cultural tradition of stories through religious songs and biblical text in programs designed to teach meditation skills. Mindfulness-based therapies that integrate the recall of a favorite religious song or biblical text would likely enhance the acceptability and participation in these and other cancer support programs.
The theme for this years’ International Cancer Education Conference (ICEC) is Integrating Culture, Spirituality, and Social Support into Cancer Education to Improve Health Equity. The goals of this conference are focused on evidence-based practices and on new and creative models of cancer care that support best practice and facilitate interdisciplinary research and educational collaborations on the national and international levels. For this conference, we broadly think of culture as a social determinant of health that considers customary beliefs, social norms, attitudes, values, and practices in a given place and time. More specifically, scholarship and practice related to culture might focus on a cancer populations’ shared language, religion, cuisine, social habits, music and arts and the ways in which this social determinant influences optimal cancer care. Together, the American Association for Cancer Education (AACE), the Cancer Patient Education Network (CPEN), and the European Association for Cancer Education (EACE) aim to create an atmosphere to use critical skills, ask questions, evaluate evidence, and engage in interesting and difficult conversations.
We hope to see you in person or virtually for our 2021 ICEC Conference.
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Hamilton, J.B. Storytelling: a Cultural Determinant of Health Among African American Cancer Patients. J Canc Educ 36, 211–213 (2021). https://doi.org/10.1007/s13187-021-01978-4
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DOI: https://doi.org/10.1007/s13187-021-01978-4