Sensitivity and Knowledge About Different Cultures Helps Communication With Patients

There has been increasing recognition of the importance of cultural competence in caring for patients and in improving patient outcomes. This subject was explored by Wael Al Zayyer, PhD, Executive Consultant at the King Fahad Specialist Hospital, Damman, Saudi Arabia, during the 12th Annual Oncology Nursing Society Institute of Learning.

There are various definitions of culture, but for the purposes of his discussion, he defined culture as a shared set of beliefs, values, and expectations of a group according to ethnicity or religion. Dr Al Zayyer made an important distinction between cultural sensitivity and cultural competence. Culturally competent care entails knowledge about that particular culture, a nonjudgemental attitude free of stereotyping, and skills that facilitate communication. Also, the practitioner has to have experience with the different communities and ethnic groups and the desire to work with people from different cultures, he said.

Training in cultural competence has gained favor around the world; in the United States, some states mandate that physicians be trained in cultural competence, while other states recommend such training. Several models for cultural competence exist, among them BATHE, BELIEF, ESFT, KLEINMAN’S, and LEARN. Whatever model is used, the practitioner has to learn normative cultural values, be aware of language issues when communicating, know about folk illnesses related to that culture, and be aware of patient and family beliefs. Domains to be considered include access to healthcare, social stressors and support network, changes of environment, feeling in control of one’s life, and literacy.

Barriers to achieving cultural competence include underrepresentation of different cultures in the healthcare workforce, complexity of healthcare organizations, lack of human and financial resources, and barriers to communication.

Dr Al Zayyer described specific healthcare issues that are affected by culture. For pregnancy and birth, cultural issues include circumcision, placenta, breastfeeding, care of the new mother, visitors after childbirth, and the role of the father. Cultures have different practices related to food preference and intolerance: preparation, types of foods, herbal treatments, use of alcohol and drugs, kosher food for Jewish people, and type of water. End-of-life practices also differ depending on culture and religion, including sharing information about terminal illness, advance directives, care of the body, and organ donation. Cultural expectations and types of support also affect palliative care. Other issues impacted by culture include gender concerns, perceptions of mental illness, and treatment beliefs.

The healthcare practitioner should show respect when communicating with people of different cultures by following expectations regarding eye contact, physical contact, and conversation limits for different groups.

The following are some examples of specific religious issues about death and dying. Hinduism holds that illness is caused by “Karma,” and patients are more likely to accept death. They prefer to be at home facing east with a lamp when dying, he said. Buddhists prefer a quiet place for death and allow organ transplant and autopsy. White is the mourning color for Buddhists. Judaism does not specify a preferred place for death, but euthanasia and assisted suicide are forbidden, and a rabbi is usually there for spiritual support. Christianity prohibits the use of human tissue obtained by direct abortion. Islamic patients pray 5 times a day, and Friday is the most important day of worship. During Ramadan, Islamic patients fast for 30 days from sunrise to sunset. Islamic patients prefer a same-sex healthcare provider, and organ donation may be allowed. The Quran is recited during illness and throughout dying, and patients face Mecca during death.

Cultural competence can reduce healthcare disparities, improve communication between the healthcare team and the patient and family, and improve outcomes. “Cultural competence promotes providing care through a holistic approach for the whole patient,” Dr Al Zayyer stated.