Week 4 - Intercultural Communication in Serious Illness Flashcards
Inequalities: care provision
- Access to good care
- Assessment and treatment of symptoms
- Inadequate information
- Psychological distress
The dual-needs model of communication
Patients 2 basic needs –>
Need to know: COGNITIVE (information) “what’s wrong, what will happen?”
Need to feel known: AFFECTIVE (empathy) “wants to be seen as person behind the illness”
Complaints: communication
Lack of caring & lack of respect
Lancet commission on the value of death - “info should be a right for all people and families who wish it”
–> what’s wrong with it and part of what dual-needs model?
“Need to feel known” (the dual-needs model of communication)
It is wrong to NOT tell everyone despite their wishes, they need to know what’s the situation!
Incurable treatment aim: “you are going to die, lets talk about quality of life”
Tell:
It is important to tell patients, and a survey shows that 99% would like to know it.
The patient (and family) has a chance to prepare for the unavoidable and deal with the mental aspects (stress, depression, anxiety etc)
NOT tell:
To tell children or not is a question of legal aspects.
Psychological effects can increase such as stress, depression, anxiety since it will lead to them living longer not feeling these mental aspects.
The whole world doesn’t talk about patients dying
E.g., Malaysia, “go home and come back if it gets better” (unconsciously everyone knows the likely outcome without it being said explicitly)
–> “still have faith”
Legal aspects: “two faced”
- Doctor has the duty to inform patient as clearly as possible, if necessary by using an interpreter (art 7: 448)
- Patient has the right not to know (art 7:449)
Three different attitudes: ???
Turkish/Moroccan attitudes about informing
about diagnosis/prognosis (living in an comparing to other in NL)
- Patients’ attitude
- Relatives’ attitude
- Clinicians’ attitude
Patients attitude:
1. A subset of patients does not want to be informed: ?
2. A subset of patients are indeed not informed: ?
3. The manner of being informed is important: ?
- elderly
- uninformed = Turkish (16-63%), Moroccan (33%)
- The Dutch directness of information-provision is disliked
Relatives attitude:
1. Family plays an important role in (not) informing patients: nr?
2. Reasons preference uninformed: 4?
- Turkish (39-66%), Morroccan (89%)
2.
* upsetting nature
* believing patients do not want to know
* might hasten death
* might stir gossip
Clinicians attitudes:
1. Clinicians not always inclined to inform patients, depends on several factors
2. Dutch clinicians find it difficult to meet communication needs
1a. Turkish oncologists informed patients(67-93%), informed relatives (8-30%)
1b. Turkish physicians more inclined to inform patients w. higher SES/education level
1c. Trained and experienced clinicians more inclined to inform patients
- due to patients lack of knowledge & cultural patterns
Inadequate information: difficulties
when families put boundaries on what can/should be communicated
Prognosis: low explicitness vs high explicitness
Uncertainty: low explicitly scored higher
Self-efficacy: high explicitly scored higher
Satisfaction: high explicitly scored higher
–> high explicitness is better!
Clinical applications
- Keep culture into consideration
- Be careful with prognosis
- Hope for the best, prepare for the worst
Language barrier: ?
Use real interpreter, not children/family members - in healthcare
