title: Toward cultural competence in cancer genetic counseling and genetics education: lessons learned from Chinese-Australians.
abstract: OBJECTIVE
  In societies such as Australia with a strong multicultural makeup, culturally determined attitudes to genetics, testing, and counseling may be incompatible with current genetics service provision.
  
  
  METHODS
  An ethnographic investigation using purposive sampling to increase subject diversity was used to explore the range of beliefs about kinship and inheritance using Chinese-Australians as a case. Participants comprised a sample of 15 Chinese-Australians who had been recruited through several community-based organizations.
  
  
  RESULTS
  The level of acculturation does not correlate with holding beliefs about inheritance, kinship, and causes of hereditary cancer that are based on "Western" biomedical or traditional concepts. Mismatch between beliefs may exist within families that can impact participation in cancer genetic testing. Family history taking that underpins the surveillance, management, and referral to genetic counseling where there is a strong family history of breast, ovarian, or colorectal cancer can also be impacted unless recognition is made of the patrilineal concept of kinship prevalent in this Chinese-Australian community.
  
  
  CONCLUSIONS
  This community-based study confirmed and validated views and beliefs on inheritance and kinship and inherited cancer attributed to senior family members by Chinese-Australians who attended cancer genetic counseling. Barriers to communication can occur where there may be incompatibility within the family between "Western" and traditional beliefs. The findings were used to develop strategies for culturally competent cancer genetic counseling with Australian-Chinese patients. These include nonjudgmental incorporation of their belief systems into the genetic counseling process and avoidance of stereotyping. They have also influenced the development of genetics education materials to optimize family history taking.
authors.affiliation: Center for Genetics Education, Bldg. 36, Royal North Shore Hospital, St. Leonards, NSW 2065, Australia.
authors.forename: Kristine
authors.initials: K
authors.lastname: Barlow-Stewart
authors.forename: Soo See
authors.initials: SS
authors.lastname: Yeo
authors.forename: Bettina
authors.initials: B
authors.lastname: Meiser
authors.forename: David
authors.initials: D
authors.lastname: Goldstein
authors.forename: Kathy
authors.initials: K
authors.lastname: Tucker
authors.forename: Maurice
authors.initials: M
authors.lastname: Eisenbruch
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People / Q000523:psychology; D001315:Australia; D002681:China / Q000208:ethnology; D003469:Culture; D005260:Female; D005817:Genetic Counseling / Q000523:psychology; D020022:Genetic Predisposition to Disease / Q000208:ethnology / Q000523:psychology*; D005820:Genetic Testing; D006723:Hong Kong / Q000208:ethnology; D006801:Humans; D008296:Malaysia / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000208:ethnology / Q000235:genetics / Q000523:psychology; D010342:Patient Acceptance of Health Care / Q000523:psychology; D010353:Patient Education as Topic; D010375:Pedigree