Role of Culture in Healthcare Decision-Making

Culture is a tool that its members use to assure their survival and well-being, as well as provide meaning to life. It has two purposes-an integrative purpose, whereby beliefs, behaviors, and attitudes are learned, which provide a sense of belonging and integrity, and a functional purpose, in which behaviors are prescribed that define a good person in a specific worldview. Culture is highly multidimensional and includes important aspects, such as communication patterns, social support, family relations, and decision-making styles.

Marjorie Kagawa-Singer, PhD, RN, FAAN

Marjorie Kagawa-Singer, PhD, RN, FAAN, professor at the UCLA School of Public Health, department of Asian American studies, Los Angeles, discussed these topics in her presentation, “The Impact of Culture on Ethical Health Care Decision-Making,” at Scripps Cancer Center’s 32nd annual Oncology Nurses Symposium, held October 7–10, in San Diego.

Conflict related to cultural beliefs within healthcare commonly arises during times of significant life change. Birth and death are examples of major transitions whose constructs are culturally framed. Our American principles of bioethics are based on Western beliefs, principally that of autonomy, having respect for the individual and honoring their ability to make decisions on their own behalf. However, other cultures such as those from Eastern origins are very sociocentric and are family-centered. There is a greater sense of collectivism, interdependence, and community. These values highly influence decision-making.

Dr. Kagawa-Singer offered the following suggestions to enhance oncology nurses’ understanding of cultural norms and their role in decision-making:

• The impact of a decision on the entire family is often considered rather than a decision’s impact on just the patient; family welfare is frequently a primary focus;

• Establishing trust with healthcare providers is paramount;

• Acknowledge the potential role of faith in decision-making;

• Ask the patient what they want to know, how they want the information communicated, and with whom should the information be shared.

Lastly, it is important for oncology nurses to remember that they come from their own culture with its established set of norms, attitudes, beliefs, and behaviors. A first step to becoming more culturally competent is to understand one’s own culture and how this impacts reactions to others. Proficiency in cultural sensitivity is becoming increasingly important as our American mosaic changes from a uniform to a highly heterogeneous blend of populace.