title: Supportive Care: Communication Strategies to Improve Cultural Competence in Shared Decision Making.
abstract: Historic migration and the ever-increasing current migration into Western countries have greatly changed the ethnic and cultural patterns of patient populations. Because health care beliefs of minority groups may follow their religion and country of origin, inevitable conflict can arise with decision making at the end of life. The principles of truth telling and patient autonomy are embedded in the framework of Anglo-American medical ethics. In contrast, in many parts of the world, the cultural norm is protection of the patient from the truth, decision making by the family, and a tradition of familial piety, where it is dishonorable not to do as much as possible for parents. The challenge for health care professionals is to understand how culture has enormous potential to influence patients' responses to medical issues, such as healing and suffering, as well as the physician-patient relationship. Our paper provides a framework of communication strategies that enhance crosscultural competency within nephrology teams. Shared decision making also enables clinicians to be culturally competent communicators by providing a model where clinicians and patients jointly consider best clinical evidence in light of a patient's specific health characteristics and values when choosing health care. The development of decision aids to include cultural awareness could avoid conflict proactively, more productively address it when it occurs, and enable decision making within the framework of the patient and family cultural beliefs.
authors: Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom.
authors: Edwina A
authors: EA
authors: Brown
authors: Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom.
authors: Hilary L
authors: HL
authors: Bekker
authors: Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors: Sara N
authors: SN
authors: Davison
authors: Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, United Kingdom; and.
authors: Jonathan
authors: J
authors: Koffman
authors: Section of Palliative Care and Medical Ethics, Renal-Electrolyte Division, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors: Jane O
authors: JO
authors: Schell
mesh_terms: D003142:Communication; D054521:Cultural Competency; D003657:Decision Making; D034462:Dissent and Disputes; D006801:Humans; D007676:Kidney Failure, Chronic / Q000208:ethnology / Q000628:therapy*; D009398:Nephrology / Q000379:methods*; D010358:Patient Participation; D010817:Physician-Patient Relations; D013727:Terminal Care
keywords: Communication; Cultural Competency; Decision Support Techniques; Ethics; Ethnic Groups; Humans; Medical; Minority Groups; Physician-Patient Relations; advanced kidney disease; chronic kidney disease; decision-making; end of life