Division of Primary Care, University of Nottingham, Medical School, Queens Medical Centre, Nottingham NG7 2UH, UK.
Br J Cancer. 2011 Sep 27;105(7):918-24. doi: 10.1038/bjc.2011.318. Epub 2011 Aug 23.
Evidence concerning the influence of ethnic diversity on clinical encounters in cancer care is sparse. We explored health providers' experiences in this context.
Focus groups were conducted with a purposeful sample of 106 health professionals of differing disciplines, in 18 UK primary and secondary care settings. Qualitative data were analysed using constant comparison and processes for validation.
Communication and the quality of information exchanged with patients about cancer and their treatment was commonly frustrated within interpreter-mediated consultations, particularly those involving a family member. Relatives' approach to ownership of information and decision making could hinder assessment, informed consent and discussion of care with patients. This magnified the complexity of disclosing information sensitively and appropriately at the end of life. Professionals' concern to be patient-centred, and regard for patient choice and autonomy, were tested in these circumstances.
Health professionals require better preparation to work effectively not only with trained interpreters, but also with the common reality of patients' families interpreting for patients, to improve quality of cancer care. Greater understanding of cultural and individual variations in concepts of disclosure, patient autonomy and patient-centredness is needed. The extent to which these concepts may be ethnocentric and lack universality deserves wider consideration.
关于族裔多样性对癌症护理临床接触影响的证据很少。我们探讨了卫生保健提供者在这种情况下的经历。
在英国 18 个初级和二级保健机构中,对来自不同学科的 106 名卫生专业人员进行了有针对性的焦点小组讨论。使用恒定性比较和验证过程对定性数据进行分析。
在通过口译员进行的咨询中,与患者就癌症及其治疗进行的沟通和信息交流通常受到阻碍,特别是在涉及家庭成员的情况下。亲属对信息的所有权和决策方式可能会阻碍对患者的评估、知情同意和护理讨论。这使得在生命末期敏感和适当地披露信息的复杂性加剧。在这种情况下,专业人员关注以患者为中心,尊重患者的选择和自主权。
卫生保健专业人员不仅需要更好地准备与经过培训的口译员合作,还需要更好地准备与患者家属口译的常见现实情况合作,以提高癌症护理的质量。需要更好地了解披露、患者自主权和以患者为中心的概念在文化和个体方面的差异。这些概念在多大程度上可能是种族中心主义的,缺乏普遍性,值得更广泛的考虑。