CULTURAL CONSIDERATIONS IN PEDIATRIC CANCERWendy N. Gray, Ph.D.
WHY STUDY CULTURE IN ONCOLOGY?
• Cancer is a family disease
• Families exist within a broader cultural system
• Increasing diversity within patients diagnosed with cancer
• Known health disparities
CULTURE IMPACTS THE CANCER EXPERIENCE
• Illness Representations
• Illness Disclosure
• Complementary and Alternative Medicine Use
• Coping
• End of Life/Bereavement
ILLNESS REPRESENTATIONS
• Illness stigma• High levels of stigma in Asian cultures. Why?• Implications of stigma?
• Illness conceptualizations• Hot-cold theory of disease• Implications?
• Illness attributions• Self-blame or guilt
IMPLICATIONS FOR CARE
• Stigma, guilt, self-blame can limit one’s ability to see out/utilize social support
• Western medicine – open dialogue vs. cultural beliefs• Undermine educational efforts
• Impact on treatment seeking behavior• Complementary and alternative medicine use
ILLNESS DISCLOSURE• Lower rates of disclosure
to child in some cultures
• Consequences of non-disclosure?
• Differences in amount of information disclosed
IMPLICATIONS FOR CARE
• Contrasting beliefs about disclosure can lead to conflict
• Culture of silence and impact on children
COMPLEMENTARY & ALTERNATIVE MEDICINE
(CAM)• Western medicine is 1st
line approach• CAM used as an adjunct
treatment• Prevalence• Type• Disclosure
GEOGRAPHIC DIFFERENCES IN CAM
Geographic Region Most Common Form of CAM
Asia, Middle East, Mexico Dietary & herbal supplements to counteract “hot” nature of cancer
Europe & North America (excluding Mexico)
Vitamins & “mind-body” treatments
CAM DISCLOSURE
• Disclosure to medical team uncommon
• Why?
• Implications of non-disclosure
COPING
• Coping styles
• Social support
• Somatization• Sleep difficulties (40-76%)• Loss of appetite (44-76%)• Weight loss (60-95%)• Headaches (47-77%)
IMPLICATIONS FOR CARE
• Provide culturally-acceptable sources of social support
• Revisit need for support over time
• Awareness of culturally-specific physical manifestations of stress = earlier intervention and support
END OF LIFE
• Communication surrounding death
• Reaction to death and expressions of grief
IMPLICATIONS FOR CARE
• Communicating difficult news in a culturally-appropriate way
• Cultural expectations for remaining in contact with family after child’s death
ROLE OF ACCULTURATION
• Individuals vary in their level of retention of their native culture
• Degree of acculturation varies across patients and within the same family
• Process of acculturation is its own stressor
CONCLUSIONS
• Limitations of existing literature• Culture issues given less attention in Western research
literature• Intersectionality
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