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Cultural aspects of communication in cancer care

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Abstract

Cultural competence in oncology requires the acquisition of specific knowledge, clinical skills, and attitudes that facilitate effective cross-cultural negotiation in the clinical setting, thus, leading to improved therapeutic outcomes and decreased disparities in cancer care. Cultural competence in oncology entails a basic knowledge of different cultural attitudes and practices of communication of the truth and of decision-making styles throughout the world. Cultural competence always presupposes oncology professionals’ awareness of their own cultural beliefs and values. To be able to communicate with cancer patients in culturally sensitive ways, oncologists should have knowledge of the concept of culture in its complexity and of the risks of racism, classism, sexism, ageism, and stereotyping that must be avoided in clinical practice. Oncologists should develop a sense of appreciation for differences in health care values, based on the recognition that no culture can claim hegemony over others and that cultures are evolving under their reciprocal influence on each other. Medical schools and oncology training can teach communication skills and cultural competence, while fostering in all students and young doctors those attitudes of humility, empathy, curiosity, respect, sensitivity, and awareness that are needed to deliver effective and culturally sensitive cancer care.

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References

  1. Anderlik MR, Pentz RD, Hess KR (2000) Revisiting the truth telling debate: a study of disclosure practices at a major cancer center. J Clin Ethics 11:251–259

    PubMed  CAS  Google Scholar 

  2. Authors Various (1997) In: Surbone A, Zwitter M (eds) Communication with the cancer patient: information and truth. Annals of the New York Academy of Sciences 809, New York

  3. Betancourt JR (2003) Cross-cultural medical education: conceptual approaches and frameworks for evaluation. Acad Med 78:560–569

    Article  PubMed  Google Scholar 

  4. Betancourt JR, Green AR, Carrillo JE, Ananeh-Firempong O II (2003) Defining cultural competence: a practical framework for addressing racial/ethnical disparities in health and health care. Public Health Rep 188:293–302

    Google Scholar 

  5. Back AL, Arnold RM, Baile WF et al (2005) Approaching different communication tasks in oncology. CA Cancer J Clin 55:164–177

    PubMed  Google Scholar 

  6. Baider L, Cooper CL, De-Nour K (eds) (2000) Cancer and the family, 2nd edn. Wiley, Sussex, Wiley, England

  7. Baile WF, Lenzi R, Parker PA et al (2002) Oncologists’ attitudes toward and practices in giving bad news: an exploratory study. J Clin Oncol 20:2189–2196

    Article  PubMed  Google Scholar 

  8. Benson J, Britten N (1996) Respecting the autonomy of cancer patients when talking with their families: qualitative analysis of semistructured interviews with patients. BMJ 313:729–731

    PubMed  CAS  Google Scholar 

  9. Blackhall L (1995) Ethnicity and attitudes toward patient autonomy. JAMA 274:820–825

    Article  PubMed  CAS  Google Scholar 

  10. Butler L, Degner L, Baile W et al (2005) Developing. communication competency in the context of cancer: a critical interpretive analysis of provider training programs. Psycho-Oncology 14:861–872

    Article  PubMed  Google Scholar 

  11. Butow PN, Kazemi JN, Beeney LJ et al (1996) When the diagnosis is cancer: patient communication experiences and preferences. Cancer 77:2630–2637

    Article  PubMed  CAS  Google Scholar 

  12. Butow PN, Maclean M, Dunn SM (1997) The dynamics of change: cancer patients’ preferences for information, involvement and support. Ann Oncol 8:857–863

    Article  PubMed  CAS  Google Scholar 

  13. Carrese J, Rhodes L (1995) Western bioethics on the Navajo reservation: benefit or harm? JAMA 274:826–829

    Article  PubMed  CAS  Google Scholar 

  14. Chiu L-Q, Lee W-S, Gao F et al (2006) Cancer patients’ preferences for communication of unfavourable news: an Asian perspective. Supp Care Cancer 14:818–824

    Article  Google Scholar 

  15. Clayton JM, Butow PN, Tattersall MHN (2005) The needs of terminally ill patients versus those of caregivers for information regarding prognosis and end of life issues. Cancer 103:1957–1964

    Article  PubMed  Google Scholar 

  16. Donchin A (2001) Understanding autonomy relationally: toward a reconfiguration of bioethical principles. J Med Phil 26:365–386

    Article  CAS  Google Scholar 

  17. Doorenbos AZ, Meyers Schim S, Benkert R, Borse NN (2005) Psychometric evaluation of the cultural competence assessment instrument among healthcare providers. Nurs Res 54:324–331

    Article  PubMed  Google Scholar 

  18. Dhruva A, Cheng J, Kwon M, Luce JA, Abrams D (2006) Contrasts, conflicts, and change: a case in cultural oncology. J Supp Oncol 4:301–304

    Google Scholar 

  19. Dunn SM, Patterson PU, Butow PN et al (1993) Cancer by another name: a randomized trial of the effects of euphemism and uncertainty in communicating with cancer patients. J Clin Oncol 11:989–996

    PubMed  CAS  Google Scholar 

  20. Elwyn TS, Fetters MD, Sasaki H, Tsuda T (2002) Responsibility and cancer disclosure in Japan. Soc Sci Med 54:281–293

    Article  PubMed  Google Scholar 

  21. Fallowfield L, Jenkins V (2004) Communicating sad, bad, difficult new in medicine. Lancet 363:312–319

    Article  PubMed  Google Scholar 

  22. Farber SJ, Egnew TR, Herman-Bertsch JL et al (2003) Issues in end-of-life care: patient, caregiver and clinical perceptions. J Palliat Med 6:19–31

    Article  PubMed  Google Scholar 

  23. Fox RC (2005) Cultural competence and the culture of medicine. New Engl J Med 353:1316–1319

    Article  PubMed  CAS  Google Scholar 

  24. Freedman B (1993) Offering truth. One ethical approach to the uninformed cancer patient. Arch Intern Med 153:572–576

    CAS  Google Scholar 

  25. Fujimori M, Akechi T, Azikuki N (2005) Good communication with patients receiving bad news about cancer in Japan. Psycho Oncology 14:1043–1045

    Article  PubMed  Google Scholar 

  26. Grassi L, Giraldi T, Messina EG et al (2000) Physicians’ attitudes to and problems with truth-telling to cancer patients. Support Care Cancer 8:40–45

    PubMed  CAS  Google Scholar 

  27. Harrison A, Al-Saadi AMH, Al-Kaabi ASO et al (1997) Should doctors inform terminally ill patients? The opinions of nationals and doctors in the United Arab Emirates. J Med Ethics 23:101–107

    Article  PubMed  CAS  Google Scholar 

  28. Higginson IJ, Costantini M (2002) Communication in the end of life care: a comparison of team assessment in three European countries. J Clin Oncol 20:3674–3682

    Article  PubMed  Google Scholar 

  29. Holland JC, Geary N, Marchini A, Tross S (1987) An international survey of physician attitudes and practices in regard to revealing the diagnosis of cancer. Cancer Invest 5:151–154

    Article  PubMed  CAS  Google Scholar 

  30. Kagawa-Singer M, Blackhall LJ (2001) Negotiating cross-cultural issues at the end of life. JAMA 286:2993–3001

    Article  PubMed  CAS  Google Scholar 

  31. Kagawa-Singer M (2003) A strategy to reduce cross-cultural miscommunication and increase the likelihood of improving health outcomes. Acad Med 78:577–587

    Article  PubMed  Google Scholar 

  32. Kalnins ZP (1997) Cultural diversity and today’s managed health care. J Cult Diversity 4:43

    CAS  Google Scholar 

  33. Koenig BA, Gates-Williams J (1995) Understanding cultural differences in caring for dying patients. West J Med 163:244–249

    PubMed  CAS  Google Scholar 

  34. Langer N (1999) Culturally competent professionals in therapeutic alliances enhance patient compliance. J Health Care Poor Underserved 10:19–26

    PubMed  CAS  Google Scholar 

  35. Levy LM (1997) Communication with the cancer patient in Zimbabwe. In: Surbone A, Zwitter M (eds) Communication with the cancer patient: information and truth. Annals of the New York Academy of Sciences, 2nd edn. New York Academy of Sciences, New York, pp 131–141

  36. Maguire P, Faulkner A (1988) Communicate with cancer patients: handing uncertainty, collusion, denial. BMJ 297:972–974

    PubMed  CAS  Google Scholar 

  37. Maguire P, Faulkner A, Booth K et al (1996) Helping cancer patients disclose their concerns. Eur J Cancer 32:78–81

    Article  Google Scholar 

  38. Matthews DA, Suchman AL, Branch WT (1993) Making connexions: enhancing the therapeutic potential of patient–clinician relationships. Ann Intern Med 118:973–77

    PubMed  CAS  Google Scholar 

  39. Monge E, Sotomayor R (2004) Attitudes towards delivering bad news in Peru. Lancet 363:1556

    Article  PubMed  Google Scholar 

  40. Mook E, Chan F, Chan V et al (2003) Family experience caring for terminally ill patients with cancer in Hong Kong. Cancer Nursing 26:267–275

    Article  Google Scholar 

  41. Mystadikou K, Parpa E, Tsilika E et al (2004) Cancer information disclosure in different cultural contexts. Support Care Cancer 12:147–154

    Article  Google Scholar 

  42. Newman J (1998) Managing cultural diversity: the art of communication. Radiol Technol 69:231–246

    PubMed  CAS  Google Scholar 

  43. Olweny C (1994) The ethics and conduct of cross-cultural research in developing countries. Psycho Oncology 3:11–20

    Article  Google Scholar 

  44. Ozdogan M, Samur M, Bozcuk HS et al (2004) Do not tell: what factors affect relative’ attitudes to honest disclosure of diagnosis to cancer patients? Supp Care Cancer 12:497–502

    Article  Google Scholar 

  45. Parker PA, Baile WF, deMoor C et al (2001) Breaking bad news about cancer: patients’ preferences for communication. J Clin Oncol 19:2049–2056

    PubMed  CAS  Google Scholar 

  46. Pellegrino ED (1992) Is truth-telling to patients a cultural artifact? JAMA 268:1734–1735

    Article  PubMed  CAS  Google Scholar 

  47. Phipps E, Ture G, Harris D et al (2003) Approaching end of life: attitudes, preferences, and behaviors of African–American and White patients and their family care-givers. J Clin Oncol 21:549–554

    Article  PubMed  Google Scholar 

  48. Russell Searight H, Gafford J (2005) Cultural diversity at the end of life: issues and guidelines for family physicians. Am Fam Physician 71:515–522

    PubMed  Google Scholar 

  49. Seibert PS, Stridh-Igo P, Zimmmermann CG (2002) A checklist to facilitate cultural awareness and sensitivity. J Med Ethics 28:143–146

    Article  PubMed  CAS  Google Scholar 

  50. Seo M, Tamura K, Shijo H et al (2000) Telling the diagnosis to cancer patients in Japan: attitude and perceptions of patients, physicians and nurses. Palliat Med 14:105–110

    Article  PubMed  CAS  Google Scholar 

  51. Sullivan RJ, Menapace LW, White RM (2001) Truth-telling and patient diagnosis. J Med Ethics 27:192–197

    Article  PubMed  CAS  Google Scholar 

  52. Surbone A (1992) Truth telling to the patient. JAMA 268:1661–1662

    Article  PubMed  CAS  Google Scholar 

  53. Surbone A (2004) Cultural competence: why? Ann Oncol 15:697–699

    Article  PubMed  Google Scholar 

  54. Surbone A, Ritossa C, Spagnolo AG (2004) Evolution of truth-telling attitudes and practices in Italy. Crit Rev Oncol Hematol 52:165–172

    Article  PubMed  Google Scholar 

  55. Surbone A (2006) Communication preferences and needs of cancer patients: the importance of content. Supp Care Cancer 14:781–791

    Google Scholar 

  56. Surbone A (2006) Telling truth to patients with cancer: what is the truth? Lancet Oncol 7:944–950

    Article  PubMed  Google Scholar 

  57. Surbone A (2006) Family, autonomy and cultural differences. In: Holland J, Baider L, Johansen C, Surbone A (eds) Care giving in context. American Society of Clinical Oncology Educational Book, pp 156–159

  58. Surbone A, Kagawa-Singer M, Terret C, Baider L (2006) The illness trajectory of elderly cancer patients age across cultures: SIOG position paper. Ann Oncol 18:633–638

    Article  PubMed  Google Scholar 

  59. Surbone A (2006) Cultural aspects of communication in cancer care. In: Stiefel F (ed) Communication in cancer care. Recent results in cancer research. vol. 168. Springer, Heidelberg, pp 91–104

    Google Scholar 

  60. Swendson C, Windsor C (1996) Rethinking cultural diversity. Nursing Inquiry 3:3–10

    Article  PubMed  CAS  Google Scholar 

  61. Taboada P, Bruera E (2001) Ethical decision-making on communication in palliative cancer care: a personalist approach. Supp Care Cancer 9:335–343

    Article  CAS  Google Scholar 

  62. Tse CY, Chong A, Fok SY (2003) Breaking bad news: a Chinese perspective. Palliat Medicine 17:339–343

    Article  CAS  Google Scholar 

  63. Vega WA (2005) Higher stakes for cultural competence. Gen Hosp Psych 27:446–450

    Article  Google Scholar 

  64. Vincent JL (1998) Information in the ICU: are we being honest with our patients? The results of a European questionnaire. Intensive Care Med 24:1251–1256

    Article  PubMed  CAS  Google Scholar 

  65. Voogt E, van Leeuwen AF, Visser AP et al (2005) Information needs of patients with incurable cancer. Supp Care Cancer 13:943–948

    Article  Google Scholar 

  66. Zweifler J, Gonzales AM (1998) Teaching residents to care for culturally diverse populations Academic Med 73:1056–1061

    Article  CAS  Google Scholar 

  67. Williams CJ, Zwitter M (1994) Informed consent in European multicenter randomized clinical trials—are patients really informed? Eur J Cancer 30:907–910

    Article  Google Scholar 

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Correspondence to Antonella Surbone.

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Surbone, A. Cultural aspects of communication in cancer care. Support Care Cancer 16, 235–240 (2008). https://doi.org/10.1007/s00520-007-0366-0

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