De Trill M, Kovalcik R
Dana-Farber Cancer Institute, Boston, Massachusetts 02115, USA.
Ann N Y Acad Sci. 1997 Feb 20;809:197-210. doi: 10.1111/j.1749-6632.1997.tb48083.x.
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.
童年和青春期的定义、理解及塑造方式差异很大。一个社区的文化生活决定了儿童如何被重视以及将采取何种措施确保他们的健康。它还将决定家庭对患病儿童的反应。正是出于这些原因，医疗保健专业人员应该对文化定义的健康信念和做法保持敏感，这些信念和做法可能解释诸如不遵守规定治疗方法、父母参与患者护理的程度和质量以及家庭与医护人员关系等行为。应该对每个家庭定期进行健康信念和做法、家庭构成、宗教仪式以及对疾病成因的信念的评估。这些评估提供重要信息，有助于设计与家庭文化传统相符的治疗方案。了解文化因素不应排除针对家庭的个性化方法。每个家庭都应以能让我们识别其个体特征以及文化定义特征的方式进行评估。这将消除在特定医疗环境中对某些行为理解不足的情况下可能出现的文化刻板印象。需要开展将健康行为与文化定义的价值观和做法相关联的研究。国际心理肿瘤学会通过其国家代表委员会目前正在调查世界各地的肿瘤学实践。近30个国家参与了这项旨在识别肿瘤学中在告知真相、姑息治疗、疼痛控制和替代医学使用方面的文化差异的尝试。这项研究的重要性不仅在于它将产生的结果，还在于它为分享专业经验和加强国际肿瘤学家之间的有效沟通所需要的共同努力。这项研究也可作为调查儿科医疗环境中肿瘤学实践的一个模型。
