Palliative Care and Socio-Cultural Interactions in French Guiana: A Case Report and Discussion

Abstract

Context : Palliative care involves global management of the patient at the end of life. In the practice of oncology, important cultural aspects of this care are not always adequately taken in account.Objective: To describe social, familial, economic and cultural aspects of end of life care through a case report of a patient with cancer of the cervix living in a multicultural setting.Data Acquisition: Mrs. X, whose case is reported, was one of the 594 patients managed at the Cayenne Oncology Unit in French Guiana between January 2010 and December 2012. Mrs. X's trusted representative in confidential matters was her 21-year-old sister, who gave oral permission for anonymized data relating to the case to be published. The search for relevant references was guided by the nature of the data and discussion between authors.Findings: Mrs. X's clinical presentation was typical for cancer of the cervix. Initial treatment was with curative intent led to incomplete resection. However, disease progression quickly made her case one of palliative management, and this raised many social, economic, family and cultural issues. These included illegal immigration, poverty, lack of structured family support, and aspects of indigenous cultural practice. The first three aspects were effectively managed by social workers. Cultural aspects, however, were not well understood. The objective was that the patient should die in her home surroundings and receive appropriate cultural death rites. This Native American patient was thought to belong to a cultural group whose death rites have disappeared. In fact, she belonged to a different group that had also lost its cultural identity. Conclusions:Knowing patients' medical history is essential to planning effective palliative care. But it is also important to understand as fully as possible their social, familial and cultural circumstances. In relation to a patient's culture, we must not rely on general assumptions but should seek to understand the specific circumstances relevant to a particular individual.