The 'right story' to the 'right person': communication issues in end-of-life care for Indigenous people

Abstract

staff need to be aware of a myriad of crosscultural issues. Although anecdotal evidence indicates that the quality of communication to Aborigines in the health care setting can be extremely varied, there seems to be very little research in this area. This article seeks to address the dearth of information in this area by presenting recent findings from Australian research that developed a model for Indigenous palliative care.The research that has been undertaken on the topic has mostly focused on communication issues from the perspective of Western medical practitioners. One such study 2 outlines frustrations felt by medical practitioners at being unable to relate to Indigenous patients and when faced with patients who were reluctant to talk. Although these issues are indeed pertinent, so too are the communication challenges faced by an Aboriginal patient and his or her family. This paper explores some communication issues faced by health care workers and Indigenous patients and their families in a health care What does this study add?This study provides the perspectives of Aboriginal people and health care workers on the important communication issues, including communicating difficult news, cultural shyness, information being taken literally, difficulty in understanding Western medical concepts, language barriers and talking to the right person. What are the implications for practice? This paper highlights the importance of communicating the right story (full and culturally appropriate information, appropriately translated and with opportunity for feedback to ensure comprehension) to the right person (recognising the importance of relationship, family and community).

The case for Aboriginal Health Workers in palliative care

“…The findings on cross-cultural fear and incompatibility, which are complex and reported in full elsewhere, 20 can only be noted in this article.…”

“…As the full findings on communication, which are published elsewhere indicate, 20 effective communication with Indigenous people in the health setting is all about giving "the right story" to the "right person".…”

Western Notions of Informed Consent and Indigenous Cultures: Australian Findings at the Interface

“…As outlined in related publications of further findings from the study, it is essential in working with Aboriginal peoples to communicate the 'right story' to the 'right person' within the community [13]. Also as documented in further findings from the study, respect for cultural traditions of communication with regards to the care of the dying is essential to avoid contributing to the possibility of 'pay back' after the person dies [14].…”

“…It was noted that in East Arnhem Land the Jungai is a particularly important person to obtain consent from in regards to body parts, including the cutting of hair. As outlined elsewhere, it is essential in Indigenous health care to speak to the 'right' person within the network of family and community relationships [13,25]. Disrespect for such traditional processes can lead to payback for the ill Indigenous person or their relatives, as well as considerable anger from family members and clinical staff.…”

Deciding what information is necessary: do patients with advanced cancer want to know all the details?

“…54,71 'Cultural interpreters', such as Aboriginal health workers, may also be helpful in providing guidance in cultural norms and facilitating understanding of illness concepts that may be underpinned by completely different worldviews. 90,91 Nonverbal communication is also important. The vast majority of oncology patients prefer face-to-face communication, 9 and randomized controlled trials of physicians' posture whilst breaking bad news have shown patients prefer physicians to sit rather than stand, and perceive those that do so as more compassionate.…”