The last three decades have witnessed a dramatic improvement in the effort to comprehend the cancer cell biology and also the genetic factors resulting in oncogenesis. Accordingly, this has resulted in substantial improvement in the status of health for patients with cancer. However, the marked health status improvement has been marked by disparities. For instance, the comparison of these benefits for Euro Americans and Asian Americans has been found to differ greatly. This is attributed to the cultural factors within this group that tends to hinder their efforts to seek the medical advances witnessed in the care for cancer care programs (Singer, par. 1). Accordingly, this paper seeks to identify the role of culture in cancer care and treatment and how cultural competence can serve as the bridge between this gapping difference.
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To facilitate this, the paper seeks to find answers to the questions like what is the relationship between cancer and the cultural aspects of society? How can medical practitioners approach this issue so that a bridge can be formed to create an avenue which will increase these communities seeking medical attention? What are the dimensions that should be addressed in an appropriate cultural competence system? Finally, what will be the benefits of such a system to American health care as a whole?
Dimensions of Culture and Cancer
Culture plays an extremely important role in the treatment and care of cancer. For instance, a study shows that only 5% to 10% of the total varieties of cancer are a result of genetic complications. This leaves a total of 90% for lifestyle factors. The study identifies lifestyle factors to include the cultural practices and values. With such a staggering percentage, it is, therefore, inevitable that the knowledge of cultural factors is a prerequisite to a competent approach to cancer. This is further evidenced by the international study of immigrants which points out that different cultures and regions are characterized by different types and rates of cancer. Furthermore, it takes an immigrant approximately ten years to start mirroring the characteristics of the new society that he or she has migrated to. For example, Asian women living in their original continent have been identified to have a rate of breast cancer that is approximately a quarter or a half of their white American counterparts. However, a single generation after immigration to America results in a similar rate as that exhibited by the American women (Singer, par. 3). This leaves one question to be answered. What are these factors that are present in the US that is absent in Asia that would subsequently affect these women after their immigration? Without doubt, the answer is culture. It is, therefore, arguable that cultural factors depicted by lifestyle such as dietary inclinations, society’s patterns of exercise, the society’s norms associated with weight, environments at work, birth rates, patterns through which the members of the society seek medical attention.
To develop an outstanding system, it is important to understand what culture is. Cross et al (p. 8) defines culture as “integrated pattern of human behavior that includes thoughts, communications, actions, customs, beliefs, values and institutions of a racial, ethnic, religious or social group” (p 8). These cultural factors form the everyday life of any individual. Accordingly, their relevance to health is, without doubt, indispensable. On their part, Brach and Fraserirector (p 28) argue that the relevance of cultural aspects in health sector is further heightened from patients of a minority descent who, unfortunately, are forced to seek medical attention from institutions that are comprised of workers from the majority members of the society.
This causes a great challenge to the medical realm. However, are there any negative implications associated with inadequate consideration of cultural aspects of a community by health practitioners? If yes, what are these implications? As mentioned above, culture determines almost every part of an individual’s life. This means that failure to address these factors would result in negative results. Firstly, failure to address cultural factors affecting health might make an individual fail to take up screening opportunities just because the individual did not have adequate familiarity of how prevalent the mentioned condition is within given ethnicities. Next, a medical practitioner who fails to put into account the cultural factors stands a chance of failing to account for varying responses to certain medication within different groups of people.
Culture and Cancer Treatment
It is a prerequisite for any medical practitioner to understand the cultural aspects of a community for him to be able to come up with a lasting solution for cancer treatment. An individual’s risk factors and also the disease’s meaning is greatly influenced by the cultural norms. In addition, culture acts as the basis of guidance from which the individual’s cognitive, social and emotional response is founded. Consequently, cancer’s entire continuum is affected by the cultural norms. This is to say, efforts for early detection, preventive measures, choice of treatment, the rates at which individuals adhere to treatment, side effect management like the control of pain, measures for psychological and social support, rehabilitation measures, survivor issues, use of hospice and end-of-life care program effectiveness (Singer, par. 7). Colon (p. 28) further argues that through culture, an individual is able to determine whether a phenomenon is a health problem or not. Furthermore, discussion and expression of symptoms are further hampered by culture. Further still, cultural environment of an individual greatly determines the reception of healthcare information and also determines the type of care that is appropriate for the patient. Finally, through culture, the way the individual exercises his rights and protections is determined.
A medical practitioner specialized in the treatment and control of cancer cannot be effective without knowledge of culture. This is because culture plays a role in all stages of cancer treatment. This means that it will become a priority for healthcare policymakers to ensure that culture is well implemented within the curriculum for medical students. This supposition is further strengthened by Colon who posits that for any effective endeavor to contain cancer, the practitioner must be adequately equipped with knowledge of the individual or the community in question’s culture. Even so, this trend has been witnessed in many medical schools. More and more students are developing an unwavering interest in the study of how culture can be used in the field of health care providers to improve the health of cancer patients and the protection of the healthy population from contracting the same. This has been emphasized in health care in what is referred to as cultural competence or cultural sensitivity (Colon 28).
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Communication is very essential in the process of cancer treatment and care. Failure in communication will directly translate to failure in the program. Communication between the patient and the medical practitioner will improve on the way the patient understands his diagnosis of cancer which is an essential step in for care provision. Healthcare practitioners should not only understand the verbal cues but also the non-verbal expressions of pain and distress. Ethical beliefs and spiritual values of the patients must, therefore, be given a first-hand priority by the health care professional. They should have a working knowledge of all dynamics that make up the overall structure of the diverse methods of interactions. Consequently, their solutions must put the various interaction structures into consideration. While a prior knowledge of historical and cultural contexts of a community can be a great way forward, the health care provider must be able to understand his own biases and also have the capacity to carefully listen to the patient and above all, be able to make judgments devoid of any subjective influences (Colon 28).
Culture oriented communication barrier may result in a mismatch of the formation or a bias interpretation of the information provided by the patient. In other cases, minority patients who might have experienced injustices or unfair treatments earlier might develop an unfavorable attitude towards the health providers. Specifically, Colon (p. 28) points out that the effect of using the word “illegal alien” might sound like a normal depiction of the individual’s residential status in the US to the healthcare provider. However, this might have negative connotations in the patient’s understanding.
In some cases, the patient’s understanding of cancer could be far from the health care professional’s understanding. For example, some societies could believe that cancer is a spiritual condition and not a physical one as the practitioner would be thinking. Furthermore, some communities believe that cancer is a punishment to an individual for having committed some sins earlier in life. Without a good understanding of this, the healthcare provider might not come up with an appropriate method and system of care for the patient. In addition, some cultures offer the family a strong position in decision-making. This means that the patient’s decision-making will be highly dependent on the family’s decisions. Accordingly, the health practitioner must consider the patient’s influence from the family before making any treatment decision (Colon 28).
A study carried out in America to identify how Japanese American women and the Caucasian Americans coped with breast cancer showed that both coped well and responded well to treatment. However, the methods of coping were completely different from each other. In fact, using the Japanese American method on the Anglo-Americans would have resulted in great failure and the opposite was true. The study showed that Japanese Americans preferred to handle cancer pains bravely but silently. They preferred to talk as little as possible to their families concerning their conditions. Contrarily, Anglo-American women coped equally well but using a method that was inversely related to this. They assertively handled the situation and also depended on verbal strength to keep them moving. Accordingly, the Japanese Americans’ support team comprised a very minimal number of confidants within the support network. On their part, the Anglo-Americans heavily depended on a large number of confidants. In fact, the number was almost three times larger than that of the Japanese Americans (Singer, par. 8). This shows that cultural awareness is a prerequisite for any efficient healthcare professional.
Application of Cultural Competence
The Association of American Medical Colleges assumes the definition of cultural or linguistic competence as “a set of congruent behaviors, knowledge, attitudes, and policies that come together in a system, organization or among professionals that enables effective work in cross-cultural situations” (p. 1). Simply put, cultural competence comes from two words; culture and competence. Culture is defined earlier in this paper while competence is defined as the possession of capacity for an individual’s effective functioning or an organization’s effectiveness in consideration of a community or individual’s cultural beliefs and practices. In healthcare, cultural competence involves the effectiveness of addressing healthcare cases with much emphasis on family-centered care while at the same time putting considerations on the cultural factors that influence the treatment of a patient or the medical service quality.
What is, therefore, is the importance of cultural competence in the provision of care to cancer patients? Cultural and linguistic competence is very essential in the process of treating and providing care for cancer patients. To begin with, cultural competence is believed by many to be a form of social justice (Brach and Fraserirector 183). In this argument, social justice acts as the avenue through which all members of the society can be access an informed consent. This provides a sense of equity to all members irrespective of their age, religious inclination, ethnicity, language, economic background, etc. Similarly, cancer patients can be benefactors to this. In order to make treatment choices, they need to be well informed about the different ways available for treatment and their side effects. This can be a pipe dream if the healthcare provider has no knowledge of the cultural background of the patient or community in question. Therefore, cultural competence leads to informed consent for cancer patients in relation to their treatment methods.
Considering the fact that ethnic minorities continue suffering from health conditions that their Anglo-American counterparts are relatively less affected, cultural competence must be a prerequisite for any effective approach to curbing the large disparity in the health outcomes as witnessed between ethnic minorities and the Anglo-Americans. This is an essential part of health care provision because much of literature has pointed out that ethnic minorities receive health care that is comparatively less and hence they are subjected to worse medical complications as compared to the Anglo-Americans (Brach and Fraserirector 184). As mentioned earlier, minority patients have been identified to benefit less from the treatment and care of cancer. This is evidenced by the case of Asian American women who were found to benefit less from the health care services as compared to the Anglo-American women. This was attributed to culture. This means that identifying avenues that would help health care practitioners to give adequate health care to cancer patients within a context that accurately comprehends the cultural backgrounds of these patients will assist improve on the health outcomes of minority patients suffering from cancer. Geiger (par. 4) simply adds weight to this matter by arguing that African Americans, native Indians and Hispanics have been found to be unlikely to attain advanced treatment for cancer as compared to the Anglo-Americans who had similar characteristics of insurance status, education level, income level, hospital type and several other factors. This is a clear indicator that the only reason that could cause this disparity is culture. It implies, therefore, that health outcome disparities that have been witnessed within the ethnic minorities will be greatly reduced. Geiger hence posits that cultural competence acts as the most appropriate method that can improve the health of ethnic minorities and other disadvantaged groups of the society.
Developing a Competent System
One of the fundamental commitments for healthcare practitioners is the provision of equitable care for each patient that is in need regardless of his ethnic, religious, or racial orientation. This means that failure to ensure this will stipulate a contravention of the professional accord (Geiger, par. 8). However, coming up with a system that is appropriate requires knowledge of the diverse dynamics that make up the different cultural perspectives within the many cultural setups in the United States of America. Although the Association of America Medical Colleges argues that there is a substantive improvement in the study and implementation of cultural competence in the health sector, Brown and Rhymes (p. 8) point out that the cultural competence in the current health sector is marked by several drawbacks and challenges. On his part, Grieger argues that the most appropriate way through which the cultural competence of any health sector can be improved is through the healthcare practitioners’ objective understanding of the points of weakness that they have so that they can develop an effective approach to make up for these weaknesses.
Several challenges face the current cultural competence efforts. To begin with, the policymakers have failed to come up with terms of agreement in defining terms and also specific identification of core approaches. For instance, they have not had means through which they could measure the changes in attitude and knowledge. In addition, the current policies have failed to come up with an appropriate measure that would show the changes in outcome. In addition, taking certain cultural characteristics and assuming that they can apply to all members of the community is a miscalculated approach. Not all members of the community might have a similar characteristic. Using this as a measure means that one is stereotyping the group. It is unlikely that every member of the society adheres to similar values, and beliefs. Without a doubt, some members of a similar society could have contrasting values (Brown and Rhymes 8).
Furthermore, the various national groups are characterized by several other minor subgroups which equally are founded on different cultural beliefs and norms. In addition, every single individual within a given subculture has specific levels of acculturation. The individual also has specific levels of assimilation (Brown and Rhymes 9). Kassim and Lakha (2003) as quoted by Brown and Rhymes posit that “Cultures are also not homogenous or monolithic. Varying levels of acculturation, assimilation, age, education, income, family structure, gender, wealth, foreign versus US-born status and refugee or immigrant status all modify the degree to which one’s cultural group membership might influence health practices and health status” (p. 9).
Another challenge for the development of a good cultural competence system comes in terms of the abstract nature of this term. For instance, cultural competence is not comparable to a technical skill of which one can easily master. In addition, this is not like a problem-solving issue where an individual will be made to develop the skills of problem-solving. Cultural competence entails “fundamental changes of the way people think about, understand and interact with the world around them” (Brown and Rhymes 10). This is a subject that needs sharing, integrating and learning. It is a phenomenon that has neither limit nor end. Cultural competence is a dynamic process.
Brach and Fraserirector point out that there are steps through which one can efficiently implement a program that will improve the healthcare providers’ cultural competence. The first step is identified as the use of interpreter services. This step calls for services from interpreters including those that are professional, ad-hoc or remote interpreters. This will offer the services of interpreting through sign and foreign language. Recruitment and retention have a great role in the effort to improve healthcare providers’ cultural competence. Through this, the institutions involved in cancer treatment should recruit workers from ethnic minorities through programs of minority residency. Promoting worker environment that encourages and motivates participation of minority workers. Developing programs that will allow minority workers to ascend to executive positions and also developing HR policies that would improve compensation for the minority workers is another method through which cultural competence could be developed. In addition, the training of the healthcare staff can also assist in developing cultural competence. Finally, competence health promotion and use of community health workers can promote health competence within a health care setup.
All the propositions and developments developed to offer remedies for cultural approaches in health care provision have a special role to play. None of them can be sidelined for an effective system. The nine steps mentioned above by Brach and Fraserirector offer a holistic approach that puts into consideration all the aspects of culture. This is an advisable approach. However, this paper seeks to identify an approach that will not only lead to learned efficiency, but will be cemented on natural orientations of the health care professionals. This method is based on recruitment and training. As mentioned above, culture is not like a problem-solving skill. In addition, it is not a certain process that can be developed. This means that training cannot be assumed as the best way forward towards cultural competence within a healthcare system.
This hence brings out the main point of the new model. This model advocates purely for emphasis on the promotion of ethnic minorities in the healthcare profession. According to this new model, recruitment and staffing should not be a random exercise. The policymakers should first identify the regions that are greatly affected in terms of cancer affliction and whose major cause has been identified to be cultural factors. In such regions, the policymakers should understand the diverse subgroups within the larger group. Then, they should frame their hiring policies to reflect the many subgroups. For example, it has been identified that women from African American ethnicity are much likely to die from breast cancer as compared to their Caucasian counterparts irrespective of a larger prevalence in the Caucasian group.
Accordingly, the healthcare provider dealing with cancer should first ensure that their staff is, at the lowest, comprised of 90% local ethnicity members. However, the issue of stereotyping must be identified. Not all African American women have similar affiliation and assimilation levels of acculturation. Within these women will be learned and illiterate, those believing in religious formations and atheists, those who were born in The United States and those who had just immigrated to the United States. To address this issue, the recruitment should ensure that it goes ahead with its recruitment systematically. To address the issue, the recruiters should first make a clear outline of the number of staff required for the particular branch. For instance, if Branch XX requires 15 health practitioners within a locality of a majority African American population, it should ensure that at least two of the professionals are Muslims, three are Christians, three are immigrants, four are Americans by birth and finally three are from a the other minority ethnicities that stay around.
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This, according to this method, is a move that will avoid learning of new cultures that can be difficult. In addition, the practitioners hired should be hired from the local churches and mosques and neighborhoods. This will help in the reduction of mistrusts. For instance, through the use of local professionals, the residents will trust the new approach. It will not look alien so that they think it was designed for other people. In addition, through the use of different practitioners from different religions within the locality, the cancer patients will not only identify with the care providers, but also the care providers will have not just acquired knowledge through attendance of cultural competence classes but real knowledge for both the religious, economic, attitudinal and family structure decision-making procedures.
The baseline of this approach is that recruitment should be local. This happens through the identification of the most affected areas, identification of the majority members of the locality and then identifying the minor subgroups like the religions and residential status. Then, recruitment should ensure that all of these are represented within the hired staff. This method is appropriate because it destroys the issue of stereotyping and incompetence due to misinterpretation. Above all, this will provide an avenue through which the health providers will be able to defeat the hurdle of learning different cultures which is very difficult.
By using this method, every little detail within the culture of a community will be addressed. Furthermore, the patients will be encouraged to seek medical attention by identifying themselves with the providers. This will reduce the instances of ethnic minorities enduring more suffering from diseases as compared to the majority. It will also reduce the instance of minorities having to seek help from systems that are purely designed for majority members. With this the behavioral risk factors will be easily identified by understanding professionals. Furthermore, this will develop a bridge over which conceptual barriers can be bypassed. The fact that healthcare providers will be members of the local community, ill formulated concepts will be identified and ironed (Singer, par. 14). For instance, Chinese Americans find it a form of lack of respect to ask questions. By using a native healthcare professional, he will understand that though questions are not being asked, it is not because there are no questions but because their culture does not allow them to ask. Accordingly, the healthcare professional will keenly identify the non-verbal cues of dissatisfaction or confusion and hence handle the case accordingly.
In conclusion, it is obvious that culture plays an important role in the determination of healthcare provision. Accordingly, ethnic minority people have been found to suffer more from health complications as compared to the Anglo-Americans. All these have been attributed to cultural beliefs and practices within the groups. However, medical systems have come to understand the problems associated with culture and hence developed ways through which they could be controlled. They have identified ways like training of staff, hiring minorities, including ethnic competence in the medical school curriculum and several other methods. These methods have equally improved the provision of healthcare within the minorities but ha not addressed the issue squarely. To this moment, the ethnic minorities remain the most affected by many health complications. Consequently, there is need for an appropriate method that will put into consideration the weaknesses provided within these methods.
As a remedy, this paper has proposed emphasis on minority hiring not just on racial or ethnic basis but through the identification of the diverse subgroups that make up the locality. After that, the healthcare service providers should then develop their staff so that it mirrors the requirements of the locality. With this cultural competence challenges will be addressed adequately. With this, the perennial problem of cultural impediments to healthcare providers will be addressed. As a result, the many people suffering from cancer will have a remedy. In addition, the whole continuum of cancer beginning with early detection and prevention through to pain control and end of life care will be approached adequately under the backdrop of culture.
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