florida chipra webinar cultural competence in shared decision-making september 25, 2012 suzanne m....
TRANSCRIPT
Florida CHIPRA WebinarCultural Competence in Shared Decision-
making
September 25, 2012Suzanne M. Bronheim, PhD
Examining Values and Beliefs
• Who has “jurisdiction”—is this health?• Is health the most important aspect of this
issue?
Slide Source: National Center for Cultural Competence ©2012
Examining Values and Beliefs
• What is health?– Absence of disease– Defined by medicine– WHO definition—physical, emotional well-being– Absence of sin/purity– Harmony (within self, with community, with
nature)
Slide Source: National Center for Cultural Competence ©2012
Slide Source: National Center for Cultural Competence ©2012
Making Shared Decisions
• Need a shared “lens” on:– Is there a problem?– What is the problem?– What are the choices?– What principles guide the choices?– Who are the decision makers?– What are the roles of the “team”?
Is there a problem?
• What is a problem that needs to be solved?– Physical
differences/limitations– Prevention of illness– Life shortening
conditions– Behavioral differences– Perceptual/cognitive
differences
Slide Source: National Center for Cultural Competence ©2012
What is the problem?
• What causes illness?– Germs– Punishment– Genes– Environment– Imbalances (e.g.
hot/cold)– Energy disturbances– Supernatural forces
Slide Source: National Center for Cultural Competence ©2012
What is the problem?
• Child’s acceptance in community
•Child’s spiritual well-being/wholeness
•Amount of time family is off from work
•Child cannot participate in family camping/sporting activities
Slide Source: National Center for Cultural Competence ©2012
What are the choices?
• What helps?– Faith/prayer– Medical treatment– Reestablishing balance (e.g. hot/cold)– Changes in life style– Community cleansing
Slide Source: National Center for Cultural Competence ©2012
What are the choices?
• Living with the situation• Seeking public supports• Tapping natural
networks of support• Keeping it secret
Slide Source: National Center for Cultural Competence ©2012
What principles guide the choices?
• Current scientific evidence
• Family/cultural tradition• Financial considerations• Child/youth choice• Religious laws/beliefs
Slide Source: National Center for Cultural Competence ©2012
Who makes the decision?
• Health/mental health care provider?• Parents?• Child/youth?• Family elders?• Community elders/leaders?• Public agencies?• Courts?
Slide Source: National Center for Cultural Competence ©2012
What are the roles of the “team”?
• Dr. is always in charge?• Parents are in charge?• Child/youth has a say?• Extended
family/community?• Equals?
Slide Source: National Center for Cultural Competence ©2012
Bridging the Gap
Slide Source: National Center for Cultural Competence ©2012
Who is on the team? Whom do you need to be involved to make a decision?
What is the most important thing to you and those on the team when making this decision? (Family and you!)
Bridging the Gap
Slide Source: National Center for Cultural Competence ©2012
E Explanation (How do you explain your illness?)T Treatment (What treatment have you tried?)H Healers (Have you sought any advice from folk/traditional healers?)N Negotiate (mutually acceptable options)I (Agree on) InterventionC Collaboration (with patient, family, and healers) Kleinman A. Patients and Healers in the Context of Culture. Berkeley, California: Univeristy of California Press, 1980.
CONTACT US
National Center for Cultural Competencehttp://[email protected]
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