PCC4U Core Module 3: Assessing and managing symptoms provides detailed information about assessment to determine a person and their family’s physical, emotional, social, cultural and spiritual needs. Management of symptoms in palliative care is focused on providing comfort and supporting the best possible quality of life.
Cultural influences
Some people have strongly held beliefs about the causes of illness and ways to stay healthy. These beliefs can appear to conflict with a Western biomedical understanding of the illness. People can also be using traditional or alternative medicine to promote health or treat illness. Demonstrating respect for diversity of beliefs and cultural practices can help to build trust and establish rapport.[1]
Concepts of health and illness can impact on a person and their family’s perception of symptoms, especially pain. For example, some people believe that pain can be a punishment for past wrongdoings. Others believe that a person’s response to pain impacts on their experience in the afterlife. Severity of pain and other symptoms can be under-reported. For many families, the end-of-life journey is an important spiritual and cultural time. There is often a desire to stay alert in order to spend time with people and pass on important cultural knowledge. For this reason, there can be a reluctance to take strong analgesics, such as morphine due to the possible side-effects of becoming tired, drowsy or confused. Concerns about becoming addicted to pain medications can also be common.[2-5]
In some families, management of symptoms can involve the use of certain foods, natural products, medicinal herbs and traditional healers. Effective communication and explanation of available management options is important to support informed decision-making. Information regarding medication and management options need to be in a format and language that the person and their family can clearly understand and is culturally-appropriate.[3-5]
Relations between genders can differ between groups. For example in some families, it is not appropriate for men and women to make physical contact or discuss certain health matters. Respectfully asking about this will help the person and their family feel more comfortable with the care provided.[1, 5-6]
Culturally-responsive communication
Maintaining open conversations is a helpful way to support quality care. Asking direct, open-ended questions can be helpful, such as:[1]
- It looks to me like you’re in pain. Can you tell me about how you are feeling at the moment?
- You seem worried. What’s worrying you?
- I’m interested to find out what you know about your illness and what you do to stay healthy?
- What kinds of things help you when you are in pain?
- What do you know about the pain medicine that you have been prescribed?
- Some patients worry that if they take the pain medications, they will become addicted. Do you have this worry?
- Some people prefer to be cared for a by a member of the same gender. What is important to you?
Thinking Points
- Consider a common symptom that people with life-limiting illness experience (eg, pain, breathlessness, fatigue, gastrointestinal symptoms etc,). Plan how you would ask a person about this symptom in a culturally-responsive way.
- What are your / your family’s cultural beliefs about this symptom and how might this influence your perception of another person’s experience? For example, in your family, is it OK to cry or moan when in pain, or is it preferable to ‘suffer in silence’?
References
- PEPA/IPEPA Project. 2022. PEPA/IPEPA Communication Guide: Supporting access to palliative care for everyone.
- Ballantyne, PJ et al. 2011. Becoming Old as a ‘Pharmaceutical Person’: Negotiation of Health and Medicines among Ethnoculturally Diverse Older Adults. Canadian Journal on Aging, 30(2), 169-184.
- Wasti, SP et al. 2011. In what way do Nepalese cultural factors affect adherence to antiretroviral treatment in Nepal? Health Science Journal, 5(1), 37-47.
- Arnold, R. 2019. Why Patients Do Not Take Their Opiods: Fast Fact #83. Fast Facts and Concepts.
- Wiener, L et al, 2013. Cultural and religious considerations in pediatric palliative care. Palliative & Supportive Care, 11(1), 47-67.
- Therapeutic Guidelines. 2023. Overview of Palliative Care. Melbourne.