Shifting Paradigm of Cancer Care: What about the Cultural Beliefs and Values of the Patient?, The
Baldwin, Celeste Mulry
Oncology nursing in 2006 remains in a constant state of flux. Those nurses and researchers in this specialized field are faced with the dilemma of providing tools to fight the battle against cancer, the illusive disease closely associated with loss of life. Clustered in this profession are the varying sub-specialties of: palliative care, pain management, symptom management, supportive care, integrative therapies, etc. Aggressive pharmacology sales coupled with the ever changing body of research and massive clinical trials nationally, cause an ever more difficult job for the nurse in oncology to sort through the data and make it useful in practice. In addition, oncology includes not one bodily system with one disease, but rather a multitude of cancers in varying organs with the underlying possibility of metastasis to other organs from the organ of origin.
The standard of care for oncology nursing requires that the nurse be aware of how every organ functions normally, how it may react to cancer, and specifically to how the varying cancers might possibly respond to the multifaceted treatment plans uniquely designed for each patient. Any given organ or system may react to the toxic treatments with potential for failure or inadequate response. Once the data is sorted, the nurse is placed in the ubiquitous role of relaying this information clearly to the patient and many times interprets findings for the physician in words the patient can understand. Often nursing hours are spent letting the patient voice their thoughts, concerns, and fears. While the patient is faced with severe and lasting bodily effects from the treatments, impending death is a looming possibility which is not often portrayed to the patient as efforts to provide hope where hope no longer exists takes precedence.
It would appear that this dilemma of fulfilling the patient’s wishes is glossed over by the dominant, white, male, medical paradigm that often lacks the sensitivity to deal with patients from another culture than their own and continues to view nurses as underlings. This is often true of some nurses in oncology practice, as well. The patient is no longer a person with unique goals and values that we have time to study and intervene for. Oncology has become more of a for-profit mechanistic effort in the realm of pharmaceuticals and less of a patient oriented field. This is directly opposed to the Post-Modem Feminist theoretical approach, which advocates and values all cultures, genders, ethnicities, and religious affiliations, specifically the underserved. Hawaiian patients are inclusive in this group as they have been victims of the white male dominant paradigm for decades and desire to live in their homeland, with their own traditions and the teachings of their ancestors. However, strangers have come to live and dominate their culture for profit without thought to preserving all the cultural components. Without the knowledge of the culture or the ability to interpret the language, it is difficult at best to allow the ancestral culture the chance to voice concerns, wishes, or hopes. Within the context of cultural competency, how can we as medical practitioners provide for the essence of the patient’s existential and wholistic being that they hold as important?
The treatment of cancer has grown exponentially over time for many decades with challenges to the latest theories about the disease a constant. Cancer treatment for multiple cultural groups, addressing the finite differences between cultures is rarely mentioned in the literature. In this special issue, we hope to address some of the cultural differences in cancer care and highlight alternative or integrative therapies utilized in treating patients. This will shed light upon the importance of assessing the culture of the patient in depth to uncover the values and belief systems they are functioning in daily. While measuring other concepts such as vital signs, functional status, mental status, and social support are required, less measurable are the cultural aspects of the patient. We spend much time devoted to meeting the requests of accrediting bodies and fulfilling their wishes as rapidly as possible to remain legitimate. However, there is less dedication, enthusiasm, and emphasis on listening to the patient and what it is they want within their culture, as compared to what the gold standard might be, or what might be called the next “saving grace” or magical elixir. Does this lack of cultural sensitivity essentially minimalize or de-legitimize the critical importance of culture from the patient’s perspective? Perhaps it does. This may suggest that attention by those working in cancer care be alerted to recognition that the patient ultimately wants to “beat” the cancer yet within the limits or boundaries of what they believe in culturally. The cultural boundaries a patient is operating from could serve the practitioner in a positive light or cause a reframing of the perspective that should be in the spotlight, namely the patient’s. This includes respecting how a culture chooses to die, be venerated, or burial traditions.
Our society in the United States is not prepared to deal with death. We gently call it “end of life ” and couch it in oncology quietly when it is time to die. We propose that palliative care, with matching excellence in pain management, be pulled away from cancer patients alone and consider that this important ally in the preparation for death be brought forward early in the diagnosis of severe illnesses, and in addition suggest that the patient’s wishes, advanced directives, and careful decrease in curative measures be recognized and moved to the forefront. Those patients that are suffering from the devastation of cancer or any terminal disease process must have their voices heard.
The role of the nurse in this instance is a natural one, as we have done this all our lives in this profession. Let us move ahead to support and advocate for the patient, within the boundaries of their culture, with their wishes in mind and their legal requests upheld.
REFERENCES
Goldsmith, B. (2005). Obsessive genius: The inner world of Marie Curie. New York: WW.Norton.
Knobf, ZM.T. (2006.) Making your life one of passion, sacrifice, triumph, and balance. Advanced Nursing Research: special interest group newsletter, 17 (1),1.
Sinclair, C. (2006). Communicating a Prognosis in Advanced Cancer. Supportive Oncology, (4) 4, 201-202.
Yarbro, C., Frogge, M. H., & Goodman, M. (2005). Cancer nursing: Principles and practice. Sudbury, MA: Jones and Bartlett Publishers.
Celeste Mulry Baldwin, PhD, APRN
Associate Editor
Essie Alberta Riley-Eddins, PhD, RN, SM, ACHNE
Founding Editor
Copyright Riley Publications, Inc. Center for the Study of Multiculturalism and Health Summer 2006
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