title: Should culture affect practice? A comparison of prognostic discussions in consultations with immigrant versus native-born cancer patients.
abstract: OBJECTIVE
  Poor prognosis is difficult to impart, particularly across a cultural divide. This study compared prognostic communication with immigrants (with and without interpreters) versus native-born patients in audio-taped oncology consultations.
  
  
  METHODS
  Ten oncologists, 78 patients (31 Australian-born, 47 immigrants) and 115 family members participated. The first two consultations after diagnosis of incurable disease were audiotaped, transcribed and coded. 142 consultations were included in the analysis.
  
  
  RESULTS
  Fifty percent of doctor and 59% of patient prognostic speech units were not interpreted or interpreted non-equivalently when an interpreter was present. Immigrant status predicted few prognostic facts, and oncologist characteristics no prognostic facts, disclosed. Oncologists were significantly less likely to convey hope to immigrants (p=0.0004), and more likely to use medical jargon (p=0.009) than with Australian-born patients. Incurable disease status and a limited life span were commonly acknowledged, generally with no timeframe provided. Physical issues were discussed more commonly than emotional aspects.
  
  
  CONCLUSIONS
  While culture did not appear to influence doctor speech, interpreters filtered or blocked much prognostic communication.
  
  
  CONCLUSIONS
  Initiatives to empower all patients to attain needed information, optimise communication when an interpreter is present and train cancer health professionals in culturally appropriate care, are urgently required.
authors.affiliation: Psycho-Oncology Co-operative Research Group (PoCoG), Transient Building, University of Sydney, NSW, Australia. phyllis.butow@sydney.edu.au
authors.forename: Phyllis N
authors.initials: PN
authors.lastname: Butow
authors.forename: Ming
authors.initials: M
authors.lastname: Sze
authors.forename: Maurice
authors.initials: M
authors.lastname: Eisenbruch
authors.forename: Melaine L
authors.initials: ML
authors.lastname: Bell
authors.forename: Lynley J
authors.initials: LJ
authors.lastname: Aldridge
authors.forename: Sarah
authors.initials: S
authors.lastname: Abdo
authors.forename: Michelle
authors.initials: M
authors.lastname: Tanious
authors.forename: Skye
authors.initials: S
authors.lastname: Dong
authors.forename: Rick
authors.initials: R
authors.lastname: Iedema
authors.forename: Janette
authors.initials: J
authors.lastname: Vardy
authors.forename: Rina
authors.initials: R
authors.lastname: Hui
authors.forename: Francis
authors.initials: F
authors.lastname: Boyle
authors.forename: Winston
authors.initials: W
authors.lastname: Liauw
authors.forename: David
authors.initials: D
authors.lastname: Goldstein
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001315:Australia; D003142:Communication; D003144:Communication Barriers; D003469:Culture; D054242:Emigrants and Immigrants / Q000523:psychology*; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis* / Q000523:psychology; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D012017:Referral and Consultation; D013637:Tape Recording
keywords: Communication; Cross cultural; Oncology; Prognosis