Cross-Cultural Issues in Academic Palliative Medicine

The definition of culture, as an integrated pattern of learned beliefs and behaviors that include thoughts, styles of communicating, ways of interacting, values, practices, and customs has evolved, over time, but the underlying understanding is that culture is the lens through which people give the world meaning and which shapes their beliefs and behaviors. Culture is a system of shared ideas, concepts, rules and meanings that underlies the way we live — and approach death. Cultural diversity refers to more than ethnic diversity; age, gender, sexual preference, capabilities, education, place of residence, and occupation also contribute to diversity of culture. [Lickiss, 2003]. Cultures change or evolve over time and this affects many areas. In palliative medicine attitudes and practices regarding care of the incurable patient, of the dying (and dead) have changed, from unspeakable neglect common to the multiple contemporary patterns.[Kellehear , 2001]. The role of culture is significant in palliative care, and how it is conceptualized and applied has enormous consequences for patients, families and health care providers. It influences communication patterns, decision-making styles, responses to symptoms, treatment choices, and emotional expression at end of life [Valente, 2004; Werth et al, 2002]. Studies show that when cultural differences are inadequately addressed, inferior care occurs, affecting trust, and leading to patient dissatisfaction, nonadherence. [Betancourt & Green, 2010; Bruera et al., 2001; Ward et al., 2004]. The progress in palliative medicine requires balancing clinical art with science while paying due attention to cross-cultural differences that influence patients’ and physicians’ attitudes toward health care matters. The importance of cultural sensitivity for oncologists is now increasingly recognized and teaching and training in cultural competence are mandatory. [Betancourt & Green, 2010; Biasco & Surbone 2009].