When it comes to making important health care decisions such as selecting between treatment options and health care providers, deciding when and where to seek care, weighing risks and benefits of medical care and deciding on end of life preferences, a person’s culture plays a significant role.

Cultural attitudes and beliefs can affect the way that people respond to pain, suffering and grief. Similarly, everyday routines such as eye contact, compliments, personal space, modesty and non-verbal communication can all be affected by a person’s cultural orientation. It is important to respect those differences, to be sensitive to cultural values and beliefs, and to be non-judgmental about them. After all, every one of us belongs to a unique culture based on beliefs and practices.

It is very important that the person’s health care professionals understand how the culture of the person that you are caring for will impact care.

What to Remember When it Comes to Culture

• A person’s cultural attitudes, values and beliefs can be as strong as those held by people who still live in the person’s country of origin or these attitudes, values, and beliefs may have shifted or changed over time.

• End-of-life ceremonies and rituals may vary greatly even within cultures.

• Sometimes family members who identify with the same culture have generational differences that arise with respect to the same cultural values and beliefs. How those differences are worked out can have a lasting impact on family members.

• A person’s willingness to accept support from a caregiver may be influenced by a number of cultural factors. One such factor is that in some cultures the family is more important than the individual. In such cultures, health-related decision-making and problem-solving are typically done as a family unit. Some health care professionals may need your help understanding this important cultural difference. Establishing a substitute decision-maker is always important but particularly important when a physician must understand the cultural values, and therefore, the choices of the patient if they are unable to convey those values, beliefs and wishes themselves.

• How a person thinks about time can also be different given the influence of culture. Some cultures are focused on the future and looking ahead while other cultures are more focused on the past or present. Sometimes such a time orientation can be a source of conflict between generations of the same family. It is important to talk about these different perspectives and come to a resolution for the support and well-being of the person being cared for.

• A person’s values, attitudes and beliefs may conflict with those of mainstream approaches to care. In some cultures it is perfectly acceptable to seek and receive help with caregiving responsibilities from people outside the family; in others, it is not. In some cases, services that are considered a threat to cultural values, beliefs and traditions will meet with little success (e.g. a family friend instead of a person’s wife providing personal care to a man).

• People who have enjoyed positive relationships with traditional community care providers such as healers and herbalists will continue to seek care from similar helpers in their new setting.

With an accepting person to listen, an ill or dying person may actually be able to talk through the meaningful events of their life and be heard without judgement…another important kind of healing. Such meaningful conversations will always have a cultural connection.  

1. Read this scenario.

Shelley is the caregiver of her Hispanic mother-in-law, Constanza. Shelley’s awareness of the Hispanic culture has come from being married to her husband for the last five years. Shelley feels as though she has a good understanding of the Hispanic culture; however, she is shocked that Constanza wishes to stop her chemotherapy in favour of some home remedies provided by the folk healer in her community.

2. How should Shelley proceed? Think about what you would do before checking the sample answer.

Sample response:

Shelley should explain that while herbal supplements recommended by a healer are an attractive alternative to pharmaceuticals, herbal supplements receive far less government regulation so it’s important to investigate whether the herbal remedies have been approved. Also, Shelley could remind Constanza that the doctor asked her to share all treatments and remedies that Constanza is trying, just to make sure they are safe.

3. Read this scenario

Alan has been appointed by his father as the substitute decision-maker for his father in a Power of Attorney for Personal Care. However, his oldest brother Sang is not at all pleased with his father’s decision. After all, in their Korean culture, the oldest male in the family is often the decision-maker and spokesperson. Alan feels the family tension deeply and feels conflicted about following his father’s wishes versus suggesting to his father that Sang take his place.

4. How should Alan proceed? Think about what you would do before checking the sample answer.

Sample response:

Alan needs to honour his father’s wishes and not create additional turmoil or conflict at this time. Alan could share all decisions with his elder brother to ensure that he feels included and is current with what is happening.

5. Read this scenario

Jian is the caregiver for Zhen. Jian comes from an extended Chinese family that has remained close for many years. Jian, like many Chinese people, believes that the behavior of the individual reflects on the family. Sadly, Zhen is suffering from mental illness which causes her to act out with no self-control. Jian loves Zhen dearly but feels shame and guilt for Zhen’s behavior. As a result, Jian is accepting no offers of help but is becoming exhausted caring for Zhen.

6. If you were a close friend of Jian’s what could you do to help in this situation? Think about what you would do before checking the sample answer.

Sample response:

Sit down with Jiam and make a list of everything that Jiam has to do to care for Zhen. Then choose some small items that will not threaten Jiam’s privacy. Complete those one or two items efficiently and successfully. Next week look at the list again and see if there are one or two more items that you could help with. Go gently while engaging Jiam in non-threatening discussions about mental illness and all the various ways it manifests itself. Help Jiam to understand that you understand.

Use these additional resources to learn more about the topic of cultural needs and how to help as a caregiver.

When Medicine and Culture Intersect
https://www.cmpa-acpm.ca/en/advice-publications/browse-articles/2014/when-medicine-and-culture-intersect

Cultural Myths Versus Realty on Caregiver Stress