Impact of culturally based medicine on patient decision-making

Article indépendant

PERSAUD-SHARMA, Dharam | KASHAN, Sanaz | BERKMAN, Aron | ROMANELLO, Tracy

This is a case of Ms. C, a 37-year-old woman originally from Zambia, Africa, with an unremarkable medical history prior to the unfortunate diagnosis of cervical cancer in 2014. Ms. C, was diagnosed with cervical cancer at an early stage with many treatment options available at the time of her diagnosis to potentially limit disease progression. Such therapeutic options included: conventional surgery, chemotherapy and radiation therapy, all commonly recognized treatment approaches for medical management, utilizing ‘westernized’ medicinal theories. Based upon the ideology of the patient's family and her own personal beliefs of healing and western medical practices, she instead opted for a culturally based complementary and alternative medicine (CAM) management of her cervical cancer and declined surgery, chemotherapy and radiation therapy. After 2 years of CAM management, her cervical cancer metastasized to her lungs and brain. After numerous hospitalizations for cancer-related illnesses and increasing symptom burden, she sought typical western medical interventions including chemotherapy, external beam radiation, along with a nephrostomy tube for renal failure and uterine artery embolization for chronic uterine bleeding. Within 6 months of such interventional techniques failing to improve her prognosis, the patient died under hospice home care. This case highlights the importance of elucidating how a patient understands their own medical condition and reconcile their belief system and cultural practices early in the management and treatment process. This is possible through emphasizing and practicing a thorough cross-cultural interview and is especially important when dealing with potentially life limiting pathologies like cancer, and when making key decisions such as choosing between CAM vs. western medicinal practices, or a holistic approach utilizing both. Physicians and patients must focus on removing cultural barriers to medical care.

https://doi.org/10.1080/09699260.2019.1581461

Voir la revue «PROGRESS IN PALLIATIVE CARE, 26»

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