Attitudes/acculturation vary among individuals in a group
- ask about health beliefs in a natural way during interview
- determine level of acceptance of Western medical concepts/system
- older people, like recent arrivals, may be less acculturated
Initially, use
- a relatively formal general approach
- conservative body language
- patient’s correct title (Mr., Mrs., Ms., Dr., Rev.,) plus
- surname unless otherwise specified
Determine
- correct pronunciation of the patient’s name
- need for interpreter, even if the patient speaks English
- literacy. (Is there a companion who can read instructions?)
Watch for signals that reveal patient’s comfort with clinician’s
- body language/facial expressions
- physical distance and physical contact
- eye contact
Be aware of possible traumatic refugee or war experiences
- patients may associate HCP with trauma or torture
Consider
- gender issues
- possible transportation constraints
Provide assurance of confidentiality
End of life/DNR decisions:
- patient’s disclosure preferences need to be elicited early, before health crisis
- family/kin decisions may take precedence over patient choices
- avoid standardized approach to “confronting” poor prognosis
- talking about death may be culturally proscribed
- disclosing poor prognosis may be perceived as adding to risk
- verbal, family directives may be preferred over written