Patient-centered care: the key to cultural competence

Abstract

Much of the early literature on 'cultural competence' focuses on the 'categorical' or 'multicultural' approach, in which providers learn relevant attitudes, values, beliefs, and behaviors of certain cultural groups. In essence, this involves learning key 'dos and don'ts' for each group. Literature and educational materials of this kind focus on broad ethnic, racial, religious, or national groups, such as 'African American', 'Hispanic', or 'Asian'. The problem with this categorical or 'list of traits' approach to clinical cultural competence is that culture is multidimensional and dynamic. Culture comprises multiple variables, affecting all aspects of experience. Cultural processes frequently differ within the same ethnic or social group because of differences in age cohort, gender, political association, class, religion, ethnicity, and even personality. Culture is therefore a very elusive and nebulous concept, like art. The multicultural approach to cultural competence results in stereotypical thinking rather than clinical competence. A newer, cross cultural approach to culturally competent clinical practice focuses on foundational communication skills, awareness of cross-cutting cultural and social issues, and health beliefs that are present in all cultures. We can think of these as universal human beliefs, needs, and traits. This patient centered approach relies on identifying and negotiating different styles of communication, decision-making preferences, roles of family, sexual and gender issues, and issues of mistrust, prejudice, and racism, among other factors. In the current paper, we describe 'cultural' challenges that arise in the care of four patients from disparate cultures, each of whom has advanced colon cancer that is no longer responding to chemotherapy. We then illustrate how to apply principles of patient centered care to these challenges.

Go to the Hospital or Stay at Home? A Qualitative Study of Expected Hospital Decision Making Among Older African Americans With Advanced Heart Failure

“…The potential presence of a directive style highlights the ethical obligation of social workers and other key members of the treatment team to ensure that the wishes of persons with heart failure are honored (Munthe, Sandman, & Cutas, 2012). Recognizing the diversity in communication styles is important, as it highlights and supports the importance of heterogeneity within the African American community, and the need to move towards a multidimensional, dynamic approach to diversity that recognizes a diversity of communication styles that can impact communication around health-care issues (Celious & Oyserman, 2001;Epner & Baile, 2012).…”

Communication with Patients Suffering from Serious Physical Illness

“…In general, it has been reported that CSTs have a role in improving communication in cancer settings [53] but also that the individual and psychological characteristics of the physicians have a role in the effectiveness of CST courses, as described above [54] . Furthermore, CSTs should consider cultural issues as an important variable for identifying and negotiating different styles of communication, decision-making preferences, the roles of family, sexual and gender issues, and issues of mistrust, prejudice, and racism, according to the patient's cultural background [55] .…”

The ‘Other’ in End-of-life Care: Providers’ Understandings of Patients with Migrant Backgrounds

“…However, these models have up to now largely neglected the role of culture and the search for meaning in the illness experience, despite evidence of disparities in the access of palliative care services by people from ethnic minority groups. (80) Epner and Baile (2012) have also drawn attention to the specific challenges that healthcare providers face when delivering care to patients who have ethno-cultural backgrounds different from their own -when cross-cultural interaction is at stake. They have argued that culture-competent care can only be provided if we depart from patient-centredness.…”

“…She urges end-oflife care providers to be aware of the fact that the simple guidelines for so-called culture-competent approaches to various ethnic groups' special needs and end-of-life preferences may create a multitude of myths about patients with ethno-cultural minority backgrounds. Epner and Baile (2012) have argued, in turn, that the literature on culture-competence focuses on 'the categorical', which is why this approach can lead to 'stereotypical thinking rather than clinical competence' (Epner and Baile 2012: iii34). Gunaratnam (2007) has problematised these models because they tend to downplay the challenges that cross-cultural interaction actually entails.…”