title: Involvement of Rabbinic and communal authorities in decision-making by haredi Jews in the UK with breast cancer: an interpretative phenomenological analysis.
abstract: This paper examines how Rabbinic and communal authorities participated in treatment decisions made by a group of strictly orthodox haredi Jews with breast cancer living in London. Semi-structured interviews were conducted with five haredi breast cancer patients. The transcripts were analysed using interpretative phenomenological analysis. Demographic and personal data were collected using structured questionnaires. All participants sought Rabbinic involvement, with four seeking rulings concerning religious rituals and treatment options. Participants' motivations were to ensure their actions accorded with Jewish law and hence God's will. By delegating treatment decisions, decision-making became easier and participants could avoid guilt and blame. They could actively participate in the process by choosing which Rabbi to approach, by providing personal information and by stating their preferences. Attitudes towards Rabbinic involvement were occasionally conflicted. This was related to the understanding that Rabbinic rulings were binding, and occasional doubts that their situation would be correctly interpreted. Three participants consulted the community's 'culture broker' for medical referrals and non-binding advice concerning treatment. Those who consulted the culture broker had to transcend social norms restricting unnecessary contact between men and women. Hence, some participants described talking to him as uncomfortable. Other concerns related to confidentiality. By consulting Rabbinic authorities, haredi cancer patients participated in a socially sanctioned method of decision-making continuous with their religious values. Imposing meaning on their illness in this way may be associated with positive psychological adjustment. Rabbinic and communal figures may endorse therapeutic recommendations and make religious and cultural issues comprehensible to clinicians, and as such healthcare practitioners may benefit from this involvement.
authors.affiliation: University College London, Department of Medicine, London W1W 7EJ, UK. kvhcoleman@yahoo.co.uk
authors.forename: Kate
authors.initials: K
authors.lastname: Coleman-Brueckheimer
authors.forename: Joseph
authors.initials: J
authors.lastname: Spitzer
authors.forename: Jonathan
authors.initials: J
authors.lastname: Koffman
mesh_terms: D000328:Adult; D001294:Attitude to Health / Q000208:ethnology*; D001943:Breast Neoplasms / Q000208:ethnology* / Q000523:psychology / Q000628:therapy*; D003256:Community Participation; D003430:Cross-Sectional Studies; D003466:Cultural Characteristics; D003657:Decision Making; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D007599:Judaism; D008131:London; D008875:Middle Aged; D010327:Pastoral Care; D010358:Patient Participation; D036301:Qualitative Research