Overview of Some Cultural Considerations

Transcription

1 Overview of Some Cultural Considerations Mark Lazenby PhD FAAN Associate Professor of Nursing, Divinity, & Middle East Studies

2 The Term Culture The ideas, customs, and social behavior of a particular people or society

3 Outline Cancer-Related Distress by: Race & ethnicity Geography Religion A challenge regarding screening

4 Cancer-Related Distress by Race & Ethnicity

5 Income & Race & Ethnicity Data from the 2005 Adult California Health Survey (N=42,879) from which 4,229 had a cancer diagnosis Controlling for sex, age, insurance status, education, cancer was associated with higher mental distress 6% of this effect was mediated by household income (t = 4.547; SE = 0.011; p < 0.001) Latinos and Hispanics saw a greater increase in mental stress than non-hispanic whites when diagnosed with cancer Alaca, H. Differential mental health impact of cancer across racial/ethnic groups: Findings from a population-based study in California. BMC: Population Health 2014;14:930.

6 Medical Expenses Longitudinal survey , in Los Angeles and Detroit 1,502 patients with breast cancer answered surveys at 9 months after diagnosis and 4 years later 12% reported having medical debt 4 years after diagnosis: 9% of whites, 15% of blacks, 17% of English-speaking Latinas, and 10% of Spanish-speaking Latinas reported debt (P=.03) 25% of women experienced financial decline at least partly attributed to breast cancer; Spanish- speaking Latinas had significantly increased odds of this decline relative to whites (odds ratio [OR], 2.76; P.006) Jagsi, R. et al. Long-term financial burden of breast cancer: Experiences of a diverse cohort of survivors identified through population-based registries. J Clin Oncol. 2014;32:

7 Finances & the Family 1009 breast cancer survivors 45 years of age at time of diagnosis who were 12 months after diagnosis at MD Anderson in Houston, TX, cross-sectional QOL and symptom distress surveys. 175 (15.6%) black 173 (15.5%) Hispanic 708 (63.3%) white Black women reported greater financial distress than white women (p=.001; ANOVA) Hispanic women reported greater family distress than white women (p=.0028; ANOVA) Morrow, PK et al. Effect of age and race upon quality of life of young breast cancer survivors. Clin Breast Cancer. 2014;14:e21.

8 Race & Ethnicity It is cultural differences by race & ethnicity or is it inadequate income, inadequate health insurance, medical debt, and family stress?

9 Cancer-Related Distress by Geography

10 Chinese American Women Residing in New York 97 immigrant Chinese women (70 [72%] breast cancer) who were in Western treatment and receiving Traditional Chinese Medicine cross-sectional surveys on symptoms and distress on MSAS-SF. Most frequently reported and most bothersome symptoms were psychological (feeling nervous, feeling sad, feeling irritable) The PSYCH and GDI had higher mean scores than PHYS subscale Lui, S et al. Symptom distress and its association with traditional Chinese medicine use in Chinese American women with cancer. Oncology Nursing Forum 2015;42:e24.

11 Emotional Disclosure among Chinese Patients in China 400 cancer patients 259 (64.8%) male 100 (25%) lung cancer 228 (57%) Stage IV Instruments Reluctance to Disclose Emotional Distress: fear of negative impact, no perceived need, no practical use, unwillingness to bother HADS as a measure of emotional distress Patient distress was negatively associated with no perceived need and no practical use. Patients with low family support scored significantly lower in all factors except fear of negative impact. Education and income affected the factor of no perceived need. Those patients having limited family support and limited education indicated a higher need for emotional support from their physicians and were more likely to open up to them. Wei, D. et al. Patient distress and emotional disclosure: A study of Chinese cancer patients. J Cancer Ed 2013;28:346.

12 Geography & Immigration Immigrant patients may have higher emotional distress. Need to educate them on what we are screening for and what we can do about their emotional distress

13 Cancer-Related Distress by Religion

14 Jewish & Arab in Israel 496 Israeli cancer patients 346 (69.8%) Jewish 150 (30.2%) Arab DT; HADS; BSI-18; Clinical interview for DSM-IV criteria for psychiatric disorders; measured every 3 weeks for 1 year ( ) DT Scores: Jewish - mean DT=4.3 (2.8) Arab - mean DT=3.6 (2.8) t/f=2.43 (p<.05). DT ROC = 3 optimal cutoff score Cohen, M. et al. Translating distress and screening for emotional distress in multicultural cancer patients in Israel. Qual Life Res 2012;21:555.

15 Muslims in Treatment in the US 21 Muslim patients with Stage III or IV cancer in treatment at MSKCC or YCC 11 (52%) women 10 (47%) GI cancer 12 (57%) expatriot patients Qualitative interviews, DT, MSAS, HADS, FACT-G, FACIT-Sp Physical symptoms carry spiritual significance (redemptive suffering) Family concerns are a source of distress Spiritual distress greater than emotional or physical Lazenby M et al. Sources of distress for Muslim patients who are in treatment for advanced cancer in the US. JPSM [In press].

16 Differing Health Beliefs & Location 57 refugee Bosnian, Iraqi, Somali refugee women living in US (Boston, MA) interviewed around health beliefs about cancer prevention: Duration of time in the US and prior exposure to Western medicine account for differences in health beliefs. Saadi, A. et al. Bosnian, Iraqi, and Somali refugee women speak: A comparative qualitative study of refugee health beliefs on preventative health and breast cancer screening. Health Issues 2015;5:501.

17 Distress Thermometer May not capture spiritual distress for some religious people Time spent in Western countries may change the nature of beliefs around health, which we need to account for in our screening

18 Challenge: Workforce

19 Access - WHO Mental Health Atlas % of global health workforce works in mental health 43% nurses 8% psychiatrists 7% psychologists 3% social workers Botswana (2.5 million inhabitants), 3 psychiatrists/100,ooo people World Health Organization. Mental Health Project Atlas. Accessed on September 30,

20 Conclusions Income, health insurance, and medical debt status may matter as much as race and ethnicity Being an immigrant (Chinese American, e.g.) may be a stressor Specific religious concerns may not be captured by the global term distress The lack of mental health providers in LMICs presents challenges for distress screening