Understanding of health, illness, symptoms and pain
The concept of health and illness is viewed differently between cultures.  Similarly, culture and society influences an individual’s perception of illness, symptoms and pain through shared behaviours, customs and beliefs.
Cultures can attribute health, illness and death to natural or supernatural causes.  Some people can have a cultural belief that pain is a punishment for past wrongdoings.  Other cultures believe that pain needs to be tolerated for access to heaven to be granted. 
Management and provision of care
Severity of pain and other symptoms can be under reported depending on the belief people hold about their attribution. Effective management of pain and other symptoms in people with a life-limiting illness requires discussion, comprehensive assessment, monitoring and the use of pharmacological and non-pharmacological management. 
Depending on the person’s understanding of the cause of pain and other symptoms, traditional management can include swimming in healing waters, making promises to their God or deity, giving offerings or sacrificing animals. [2, 4] Rituals can be held to remove evil spirits from the body and mind and can include the use of amulets, special clothes, herbs and traditional remedies. 
In some cultures, management of illness and symptoms can involve the use of foods, natural products, traditional medicinal herbs and traditional healers. Familiarity and trust may be built over a long period of time and connection between individuals and their traditional healer.  While traditional healers and herbal medicines are often easily accessible in some cultures, this may not be the case in Australia with traditional healers and treatments possibly more difficult to access.
Effective communication and explanation of available management options is imperative to allow people with a life-limiting illness and their family to make informed decisions.  Information regarding medication and management options need to be in a format and language that the person and their families can clearly understand and is culturally appropriate. 
Cultural values can also influence beliefs about who provides care for a person. In some cultures, shame, embarrassment and a perceived loss of self-respect can be experienced if a person is cared for by a member of the opposite sex.  In some cultures, people do not recognise a person of the opposite gender, impeding therapeutic communication.
- Select one cultural group. Review some literature to describe the common traditional beliefs held about pain and other symptoms within that cultural group.
- What are your cultural beliefs about this?
- How would you take these beliefs into consideration in your practice?
- Ballantyne, P. J., Mirza, R. M., Austin, Z., Boon, H. S., & Fisher, J. E. (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, S. P., Randall, J., Simkhada, P., & van Teijlingen, E. (2011). In what way do Nepalese cultural factors affect adherence to antiretroviral treatment in Nepal? Health Science Journal, 5(1), 37-47.
- Arnold, R. (2009). Why Patients Do Not Take Their Opiods: Fast Fact #83. Fast Facts and Concepts. . Retrieved 19 January, 2015, from www.mypcnow.org/blank-aw14v
- Wiener, L., McConnell, D. G., Latella, L., & Ludi, E. (2013). Cultural and religious considerations in pediatric palliative care. Palliative & Supportive Care, 11(1), 47-67.
- Lanken, P. N., Terry, P. B., DeLisser, H. M., Fahy, B. F., Hansen-Flaschen, J., Heffner, J. E., Levy, M., Mularski, R. A., Osborne, M. L., Prendergast, T. J., Rocker, G., Sibbald, W. J., Wilfond, B., & Yankaskas, J. R. (2008). An Official American Thoracic Society Clinical Policy Statement: Palliative Care for Patients with Respiratory Diseases and Critical Illnesses. American Journal of Respiratory and Critical Care Medicine, 177(8), 912-927.
- Palliative Care Expert Group (Ed.). (2010). Therapeutic guidelines: palliative care (3 ed.). Melbourne, VIC: Therapeutic Guidelines Limited.
- Queensland Health. (2012). Literature review: Best practice multicultural policy implementation. Retrieved from www.health.qld.gov.au/qhpolicy/docs/gdl/qh-gdl-080-att-b.pdf
- Shahid, S., Bessarab, D., van Schaik, K. D., Aoun, S. M., & Thompson, S. C. (2013). Improving palliative care outcomes for Aboriginal Australians: service providers’ perspectives. BMC Palliative Care, 12(26).