title: Bridging cultural differences in medical practice. The case of discussing negative information with Navajo patients.
abstract: BACKGROUND
  Cultural differences between doctors and their patients are common and may have important implications for the clinical encounter. For example, some Navajo patients may regard advance care planning discussions to be a violation of their traditional values.
  
  
  OBJECTIVE
  To learn from Navajo informants a culturally competent approach for discussing negative information.
  
  
  METHODS
  Focused ethnography.
  
  
  METHODS
  Navajo Indian reservation, northeast Arizona.
  
  
  METHODS
  Thirty-four Navajo informants, including patients, traditional healers, and biomedical health care providers.
  
  
  METHODS
  In-depth interviews.
  
  
  RESULTS
  Strategies for discussing negative information were identified and organized into four stages. Assessment of patients is important because some Navajo patients may be troubled by discussing negative information, and others may be unwilling to have such discussions at all. Preparation entails cultivating a trusting relationship with patients, involving family members, warning patients about the nature of the discussion as well as communicating that no harm is intended, and facilitating the involvement of traditional healers. Communication should proceed in a caring, kind, and respectful manner, consistent with the Navajo concept k'é. Reference to a third party is suggested when discussing negative information, as is respecting the power of language in Navajo culture by framing discussions in a positive way. Follow-through involves continuing to care for patients and fostering hope.
  
  
  CONCLUSIONS
  In-depth interviews identified many strategies for discussing negative information with Navajo patients. Future research could evaluate these recommendations. The approach described could be used to facilitate the bridging of cultural differences in other settings.
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, and the Bioethics Institute, Johns Hopkins University, Baltimore, MD 21224, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Carrese
authors.forename: L A
authors.initials: LA
authors.lastname: Rhodes
mesh_terms: D001130:Arizona; D003431:Cross-Cultural Comparison; D003466:Cultural Characteristics; D015438:Health Behavior; D006801:Humans; D007198:Indians, North American / Q000523:psychology*; D009341:Negativism; D010817:Physician-Patient Relations; D011364:Professional Practice; D011795:Surveys and Questionnaires