Week 6 Review Challenge-SME

Article #1; Cross-Cultural Care and Communication
1. Discuss cross-cultural care and communication.

a. Cross cultural care involves the patient's, the clinician's, and the
culture of medicine. All three cultures influence the outcome of the
encounter. To understand patients, it is first necessary to recognize
our own cultural beliefs, values, and behaviors, as well as personal
life experiences that have influenced the way we think about health
care and make clinical decisions. In addition, the culture of
medicine has its own particular beliefs, values, and customs (eg,
the idea of patient autonomy and the value placed on scientific
evidence). Finally, the patient's social and cultural background
affect the quality of understanding and communication that occurs
in the clinical encounter. Health literacy is a key component of
communication.
2. Discuss how to assess core cross-cultural issues.
a. Five core cross-cultural issues that should be taken into account
are: styles of communication; mistrust and prejudice; decisionmaking and family dynamics; traditions, customs, and spirituality;
and sexual and gender issues. Once a potential core issue is
recognized, it can be explored further by inquiring about the
patient's own belief or preference, which may be quite different than
the "cultural norm."
3. Discuss how to explore the meaning of illness with a patient.
a. Their overall conceptualization of their illness has been called the
patient's explanatory model [1].
The explanatory model represents the "meaning of the illness" for the
patient, or how they understand and explain their condition. Patients'
explanatory models can range broadly, from the mundane to the exotic,
and may be more complex than what is initially apparent. Understanding
these models is useful for all patient encounters, but particularly so for
patients whose perspectives on health and illness may differ significantly
from the Western model of biomedicine.
Common sense and lay health beliefs are the most typical type of
explanatory model. Limited education, low health literacy, lack of
information, or mistrust of medicine may lead people to develop their own
ideas about the causes, consequences, and appropriate treatment of their
illness. Sometimes beliefs are simply misunderstandings about medical
information, such as the idea that diabetes can be controlled by avoiding
sugar.
There is individual variation in how tightly people adhere to their beliefs.
Some will be happy to learn "the truth" from a physician. Others will ignore
whatever they are told if it doesn't take into account their own particular
perspective and respect their common sense.
What do you think may have caused the problem? This question gets at the patient'
sbeliefs about the cause of the illness, the most fundamental and important aspect of the
explanatory model. Clinicians have developed their own personal styles and phrasing,
modified to suit the particular situation, to address this question.
What do you call the problem? This question may be especially useful when you
suspect the patient believes a particular folk illness to be causing the symptoms. Another
way to phrase this would be, "Do you have a name for this sickness (in your language)?"
Why do you think it started when it did? This can help link the illness to certain events
in the patient's life that may be important elements of the explanatory model. A related
question is, "What was going on in your life at the time that this illness started?"
What do you know about the illness and how it works? This gets at the patient's
deeper understanding of the illness and how it affects him or her. Patients may not be
able to answer this, just as patients who believe that viruses cause colds most often
would not be able to describe how this works.
How severe is the illness? How worried are you about it? Patients may be very
worried about an illness while the physician is not, when symptoms do not suggest a
concerning disease. The opposite may also be true, when the patient feels the illness to
be minor and does not fully believe the physician's diagnosis. This is important to discuss
as openly as possible.
What kind of treatment do you think you should receive? What are the most important
results you hope to get from this treatment? Part of the patient's understanding of their
illness has to do with their beliefs about its treatment. Traditional and alternative healers
and remedies play a large role in many patients' perspective on health and illness. They
may also have opinions on Western medical therapy as well, which should be taken into
consideration.
What are the chief problems the sickness has caused? This is a good way to discuss
the effect that the illness has had on the patient's life and daily routine. Understanding
this allows better insight into the patient's unique illness experience. Other ways to
phrase this include, "How has this illness affected your life?" or "What has changed in
your life since this illness started?"
What do you fear most about the sickness? This is a crucial question; it allows the
physician to tailor his or her explanation of the illness and its treatment to the patient's
concerns. This can also be extremely helpful to understand a patient's perspective on a
particular medication or procedure.
4. Discuss the four components of the patient-based approach to providing

quality cross-cultural care.
Assessing core cross-cultural issues, exploring the meaning of illness, determining the
social context: (Three specific aspects of the patient's social text have particular relevance
to the cross-cultural clinical encounter: change in environment (such as migration);
literacy and language; and life control, social stressors, and supports
, )and engaging in negotiation.
- the five key areas to asses are : Styles of commication ( be senstivie to perferences of patient , ask
for pateitns input and encorugae verbalization)
, mistrust and prejudice- mistrust can affecte patient service, African American particualry mistrufusul
according to surveys (Tuskegee)
-pateints my ask why a test is necessary-> ask for aptients perspective and build partnership to avoid
this COMMUNCIAITON IS KEY
- decision making and family dynamics-> find out if patients want autonomy or wants family involved
( cultures may look to higher authority or decide things for patient, wont let patient know about htings
to help them, laws protecting patient in abuse should supersed anything)
traiditons customs spirituality,
-sexual and gender issues- be snetive to pateints views on discussin sexual issues opnly, explain why
you are doing it, if they are conservative
-realize their ideas may differ from yours-> respect to mantian relationship
Article #2; Overview of Spirituality in Palliative care

1. Discuss the four components of the FICA spiritual history tool.
a. Faith and Belief: Do you consider yourself spiritual
b. Importance What importance does your spirituality have in your life
How does it influence the care you may receive or how you take care of
yourself
c. Community: Are you part of a spiritual or religious community, is this is
of support to you, and how?
d. Address How would you like, your healthcare provider,to address these
issues in your healthcare
2. Discuss the various categories of spiritual distress.
a. Handle on own: abandonment issues, despair, grief, isolation or guilt.
b. Need to refer to chaplain: Issues in regard to higher being, some type of
religious or spiritual struggle, existential concerns.
3. Discuss the role of the chaplain in the interdisciplinary care team.
a. All members of the interdisciplinary team interact with patients,

including responding to and addressing all dimensions of
patient care: spiritual, religious, and existential as well as the
psychological, physical, and social. Each of these components
of care provides insight into the patients suffering and his or
her ability to manage that suffering. Spiritual counseling,

treatment of spiritual distress.
2. Evaluation:
1. What topic did you find the most interesting in the six weeks of discussions?
a. What we found most interesting was learning about the various organ
transplantation laws in the United States of America. Including the ethics
behind the issue, the governing body for organ transplantation (United
Network for Organ Sharing). How its illegal to sell organs in the USA.
2. What do you think is the most important point you learned from each week of
discussion?
a. Week 1= Importance of spirituality in a patients care and who you can
specifically refer to EG a chaplain.
b. Week 2= AOA code of ethics because we had never seen it before and the
importance of adhering to it in our future profession as osteopathic
professions. Especially the importance of section 17 and receiving gifts
from companies.
c. Week 3= Organ stuff
d. Week 4= The baby M case was most interesting because of the importance
of contracts and how individuals were able to circumvent contracts, such
as the biological mother even though she signed the baby away, she was
able to gain some rights.
e. Week 5= Differing definitions of death, and how individuals approach
each. Also the different professional criteria that have tried to more
precisely define what is death, what is an irreversible and reversible coma.
3. What did you think of the text and other materials used in the course?
a. The text and materials were adequate for our purposes, but for true
understanding of these issues I think you need to see it in real life,
probably which we will see through rotations, intership, working, etc.
4. What did you think of the format used?
Generally liked the format. Better than a one week DSP course with an
exam at the end.

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Article #1; Cross-Cultural Care and Communication

1. Discuss cross-cultural care and communication.

4. Discuss the four components of the patient-based approach to providing

Article #2; Overview of Spirituality in Palliative care

a. All members of the interdisciplinary team interact with patients,

her ability to manage that suffering. Spiritual counseling,

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