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University of Basel

Cancer. (01/2023)

Cultural diversity on the cancer ward.

Text: Samanta Siegfried

Our cultural background shapes how we deal with illness and death. Two medical ethicists from Basel are studying how cultural differences manifest when children of migrant families have cancer.

child in a hospital bed with an infusion line
Pediatric oncology: language barriers and culturally shaped views of disease and death. (Symbol image: iStock)

Nearly 40 percent of the Swiss population is made up of immigrants and their direct descendants. This cultural diversity can also be seen in the healthcare system: Not only do some of the medical staff themselves come from other countries; but on top of that, they also work with patients who have diverse cultural backgrounds. That applies to children with cancer and their families, too. How do patients and staff each experience and approach discussions about disease progression, treatment options and prognoses, given their linguistic and cultural differences?

“Providing children and families with comprehensive, attentive care is already a massive undertaking,” says Michael Rost of the Institute for Biomedical Ethics, who, together with Milenko Rakic, conducted a study examining the perspectives of different occupational groups working in pediatric oncology in Switzerland. “The results of our study clearly showed that encounters with children and families from different cultures present additional challenges.”

Challenges in communication

In the main, these challenges related to language barriers, but they were also caused by differing value systems and understandings of disease. “For example, we might have a situation in which the parents don’t want to share the poor prognosis with their child,” says Rost, “or maybe the family has different views regarding treatment options.” Of course, these situations can occur regardless of the family's cultural background. Another topic that is strongly influenced by culture is the way families deal with death and dying.

Yet the medical staff surveyed generally perceived their interactions with patients and families with a migrant background as instructive and helpful. “Most of the participants reported being able to reflect on their own values or any stereotypes during their interactions,” says medical ethicist Milenko Rakic. To strengthen their skills in these areas, staff need more intercultural training to help them, on the one hand, to engage with people from other cultures and, on the other, to examine their own cultural biases. Achieving this would require the expansion of existing services, like professional interpretation and cultural mediation or specially tailored training and continuing education programs. “But continuing education programs need to be designed with specific occupational groups in mind,” emphasizes Rakic.

After all, one of their survey's key findings was that the necessary intercultural skills varied between individual occupational groups. “A social worker deals with different topics than a nurse, a senior physician or an occupational therapist,” says Rakic. In order to achieve the desired effect, these differences must be considered. “We all know that resources are very limited in the healthcare system,” says Rost. “So, we have to work out precisely what kind of support is effective.” According to Rost, it’s ultimately a question of medical ethics: how to equitably distribute scarce resources.

In a further study, the two researchers reviewed the effectiveness of existing continuing education programs. One key finding was that studies on the effectiveness of continuing education programs focused almost exclusively on the perspective of healthcare professionals. “The critical perspective of the families involved is missing a lot of the time,” says Rost.

The families' point of view

Based on this discovery, among other factors, the two researchers are currently conducting an interview study that will allow the families to share their side of the story and report on their experiences in pediatric oncology.

This is extremely important for many reasons, not least of which is the medical perspective: “We know from the research that when a person has a negative experience in the healthcare system – if they feel they’ve been treated insensitively or disrespectfully – that can cause them to wait too long to seek medical care in the future,” says Rost. “If, alternatively, they receive holistic care that is sensitive to their culture, religion and spirituality and ultimately creates cultural safety, that often substantially improves the quality of life for these families.”

More articles in this issue of UNI NOVA (May 2023).

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