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MEDLIB-L  October 2015, Week 1

MEDLIB-L October 2015, Week 1

Subject:

Summary: Withholding information

From:

Patti Reynolds <[log in to unmask]>

Reply-To:

Patti Reynolds <[log in to unmask]>

Date:

Thu, 1 Oct 2015 19:03:26 +0000

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (120 lines)

I received such terrific responses from so many of you to my question of withholding information


I have the "Cultural Sensitivity: A Pocket Guide for HC Professionals" from the Joint Commission. Would you like me to scan the section on "End of Life" for "Hispanic/Latino"? it's short and I'd be happy to.   (this was excellent)


http://www.scu.edu/ethics/practicing/focusareas/medical/culturally-competent-care/chronic-to-critical-austerlic.html


I can't speak to other cultures, but I can tell you that we're under strict orders from my mom to lie to her about any bad prognosis. She's DC born and raised!



While not specific to Venezuela, the following excerpt from the GUIDE TO CULTURALLY COMPETENT HEALTH CARE - 3rd Ed. (2014) focuses on the Latino Culture of Brazil. It seems to concur to your patient's family Hope this helps Vida

Health-Care Practices

* Most Brazilians do not talk about their illnesses unless the illnesses are very serious. Generally, illness is discussed only within the family. Many Brazilians feel that talking about an illness such as cancer negatively influences their condition.

* Do not disclose the patient's health condition to others. Accept that some patients may not want to talk about their illness.

* Because many Brazilians tend to shun hospitals, when they are hospitalized their families accompany them and stay around the clock. The patient is often brought food from home. The family is the nucleus of responsibility for health care and is eager to participate in care.

* Include the family in care of the patient whether in the hospital, long-term-care facility, or at home.

* Brazilians residing in the United States are legally required to have health insurance. However, many cannot afford to pay for medical care and thereby revert to self-care.

* Brazilians are known for their self-medication practices. Antibiotic, neuroleptic, antiemetic, and most other prescription drugs are easily obtained over the counter in Brazilian pharmacies. Once in the United States, it becomes difficult to obtain the many drugs readily available in Brazil. Customarily, incoming Brazilians bring medicines requested by their friends and thus maintain the circulation of medications not available to Brazilians living in the United States.

* Encourage patients to fully disclose the use of all medications and treatments so they do not conflict with prescription medicines.

* Because Brazilians tend to self-medicate, the procurement of necessary health care is often avoided or delayed. Consulting with someone who has the same condition or with friends who know someone who has a similar condition may be the first step taken. A trip to the local pharmacist may be the second. A third response may be a telephone call to Brazil asking for a particular medicine.

* The Brazilian culture is rich in folk practices and depends on geographic region, ethnic background, socioeconomic factors, and generation. Many Brazilians prefer to use homeopathic medicines and herbs. Traditional and homeopathic pharmacies are supplemented by remedios populares (folk medicines) and remedios caseiros (home medicines).





Interesting article with a Central American example:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2835490/




From what I know, many cultures, other than ours, find it disrespectful or harmful to the patient to discuss end of life issues.  Venezuelans are very family oriented, so that may play a part in the family asking to withhold this information.  I would be interested in seeing what others write about it, especially if there is a Librarian from Venezuela!
thanks for posting this interesting question!  Claudia


Opinion of one of our MD's from Venezuela: Well it depends,

It should not be a big deal depending on the Lady's personality. It is very common in our culture "not to tell" our beloved ones what is happening with then although if the person is knowledgeable enough will definitely infer that something is awfully wrong with them. The dilemma comes when the person has lived in a different culture for too long, Venezuelans have the ability to absorb different cultures and make them their own so it the patient has been too long in the states, for example, might end up being offended by what otherwise would be a normal behavior of her family back home.

If Patricia wants to have further discussion or advice from a Venezuelan MD please feel free to share my contact.

Hope this is useful,


One of the references our hospital uses is  Andrews, Janice D.  (2005).  Cultural, Ethnic and Religious Reference Manual for Healthcare Providers. JAMARDA Resources, Inc. Under Hispanic/Latino ethnicity it states,  "The family may not be supportive of a terminally ill relative being told a grim prognosis. It is believed that if the person is told, it prevents enjoyment of whatever life is left."
The citation it has for that statement is Soto, A. and Villa, J. (1990). Una platica: Mexican American approaches to death and dying. In J. Parry, Social work practice with the terminally ill: A transcultural perspective. (pp. 113-127). Springfield: Charles C. Thomas, Publisher.
There's no specific indication that it would be useful in the Venezuelan population, though.




We have a LibGuide that was created with the Pediatric Palliative Care team. While there is nothing specific from Venezuela or for middle age women, you may find this helpful.

Mexican American (See Death and Dying): http://libraryguides.umassmed.edu/content.php?pid=94770&sid=1152829

"In many cultures, it is common for a serious diagnosis, such as cancer, to be withheld from the patient and given only to the family. It may be the thought to create a sense of hopelessness and hasten the dying process. For a Mexican American, the stress of knowing his or her condition will only cause him or her to get worse, moreover the very devout may believe that only God knows when some will die. For the health care staff, however, honoring the patient's culture may mean ignoring the American values of honesty and individualism as well as create potential legal complications regarding the patient's "right to know."

Home page for guide: http://libraryguides.umassmed.edu/content.php?pid=94770&sid=1360063

The Index of Cultures has the country/region specific information.



Although this situation sounds daunting, it is actually rather simple in most cases.

                In my capacity as both a bioethicist and practicing physician, the way my teams have dealt with this is to ask the patient what he or she wants to know. This occurs throughout the world, since most cultures are communitarian rather than individualistic. Often, we have had patients simply tell us to talk to their adult child (usually oldest son) and the patient will be told what is appropriate.

                This practice preserves patient autonomy and their cultural norms. Patients need only make a decision about what they want to know.

                Hope that helps.







I know from my experience as a family member, the patient already knows or suspects the prognosis. Asking the patient is a great solution to having the family members start a dialog with the patient, which is difficult, but important.


Patti- anecdotally, this was my experience as a nursing student in the late 1980's. It was very routine in England to withhold this type of news, and as a nurse it was always a challenge to try to remember who knew and who didn't. So I don't think it is a specifically Latino cultural norm or not, but there might be a link between this practice and a more authoritarian culture in medical decision making and deference to physicians.













Patricia Reynolds
Director, Bishopric Medical Library
Sarasota Memorial Hospital
Sarasota, FL 34239
941-917-1730
941-917-1646 - fax
[log in to unmask]<mailto:[log in to unmask]>
http://www.smhcs.org/p.aspx?p=431
Preventable harm is still the third-leading cause of death

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December 2004, Week 5
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March 2003, Week 5
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December 2002, Week 5
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December 2000, Week 5
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December 2000, Week 1
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October 2000, Week 1
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December 1999, Week 5
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December 1998, Week 5
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March 1998, Week 3
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March 1998, Week 1
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January 1998, Week 5
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December 1997, Week 5
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December 1995, Week 5
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