The child with cancer. Influence of culture on truth-telling and patient care.

The definition, understanding, and shaping of childhood and adolescence vary widely. The cultural life of a community determines how children are valued and what measures will be taken to insure their health. It will also determine the family's responses to an ill child. It is for these reasons that health-care professionals should be sensitive to culturally defined health beliefs and practices that may explain behaviors such as nonadherence to prescribed therapies, the degree and quality of parents' involvement in patient care, and the family's relationship with health-care staff. Assessments of health beliefs and practices, family composition, religious rites, and beliefs about illness causation should be routinely made on each family. These assessments provide important information that will facilitate the design of treatment plans that are congruent with a family's cultural heritage. Knowledge of cultural factors should not exclude an individualized approach to families. Each family should be evaluated in ways that allow us to identify their individual as well as culturally defined characteristics. This will eliminate the cultural stereotyping that may occur in the context of behaviors that are not well understood in a particular health-care setting. Research studies in which health behaviors are correlated with culturally defined values and practices need to be carried out. The International Psycho-Oncology Society, through its National Representation Committee, is currently investigating oncology practices around the world. Nearly 30 countries are participating in this attempt to identify cultural variations in truth-telling, palliative care, pain control, and use of alternative medicine in oncology. The importance of this study lies not only in the results that it will yield, but also in the joint effort that it has required to share professional experiences and to enhance efficient communication among oncologists internationally. This study may also be used as a model to investigate oncology practices in pediatric health-care settings.