Cross-cultural care and communication
- Joseph R Betancourt, MD, MPH
Joseph R Betancourt, MD, MPH
- Associate Professor of Medicine
- Harvard Medical School
- Alexander R Green, MD, MPH
Alexander R Green, MD, MPH
- Associate Professor of Medicine
- Harvard Medical School
- J Emilio Carrillo, MD, MPH
J Emilio Carrillo, MD, MPH
- Associate Professor of Clinical Public Health and Medicine
- Weill Medical College of Cornell University
The impact of sociocultural factors, race, ethnicity, and limited English proficiency (LEP) on clinical care is increasingly important in the delivery of quality health care and is the focus of a growing body of literature [1-9]. Sociocultural background influences a patient's perspectives, values, beliefs, and behaviors regarding health and wellbeing. These factors give rise to variation in recognition of symptoms, thresholds for seeking care, comprehension of management strategies, expectations of care (including preferences for or against diagnostic and therapeutic procedures), and adherence to preventive measures and medications.
Sociocultural differences between patients and providers influence communication and clinical decision-making. Evidence clearly links clinician-patient communication to patient satisfaction, adherence, and health outcomes [10-12]. Lower-quality care may result when clinicians fail to recognize and understand sociocultural differences between their patients and themselves .
The field of cross-cultural care focuses on the ability to communicate effectively and provide quality health care to patients from diverse sociocultural backgrounds. There is no empirical literature comparing the effectiveness of different models of cross-cultural care and communication. There is excellent empirical evidence showing that efforts to educate health care clinicians in cross-cultural care improve knowledge and good evidence that they improve attitudes and skills [14,15]. Accreditation groups for undergraduate and graduate medical education in the United States require training in cultural competency and racial/ethnic disparities and a curriculum guide has been developed for trainees and practitioners in primary care . The Joint Commission introduced cultural competency guidelines and standards, which include training of clinical staff practicing in the hospital environment . The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) will impact hospital Medicare reimbursements by measuring clinician-patient communication as a major determinant of satisfaction scores . The development of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Cultural Competence Item Set promotes efforts to study the impact of cultural competency on patient satisfaction .
This topic will identify the key issues faced when caring for patients from diverse backgrounds and provide a framework for an effective clinical encounter. These recommendations are based on a combination of expert opinion and, when possible, evidence from related literature such as the field of clinician-patient communication. Other issues related to the patient-provider relationship are discussed separately. (See "A patient-centered view of the clinician-patient relationship".)
Culture is a system of beliefs, values, rules, and customs that is shared by a group and is used to interpret experiences and direct patterns of behavior. Culture plays a large role in shaping each individual's health-related values, beliefs, and behaviors, and clearly impacts clinical care.
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- DEFINING CULTURE
- CROSS-CULTURAL CARE AND COMMUNICATION
- Increasingly diverse population
- Effective communication
- Racial and ethnic disparities in health care
- Accreditation standards and quality measures
- Skills for cross-cultural care
- THE PATIENT-BASED APPROACH
- Assess core issues
- - Styles of communication
- - Trust
- - Family dynamics
- - Traditions, customs, and spirituality
- - Sexual and gender issues
- Explore the meaning of illness
- - The explanatory model
- - Belief systems
- - Alternative therapies
- Determine the social context
- - Environment change
- - Language and literacy
- - Life control, stress, and support
- Engage in negotiation
- Assess for understanding
- SUMMARY AND RECOMMENDATIONS