Informed Consent in a Multicultural Cancer Patient Population: implications for nursing practice

Abstract

Obtaining informed consent, an ethical obligation of nurses and other health care providers, occurs routinely when patients make health care decisions. The values underlying informed consent (promotion of patients' well-being and respect for their self-determination) are embedded in the dominant American culture. Nurses who apply the USA's cultural values of informed consent when caring for patients who come from other cultures encounter some ethical dilemmas. This descriptive study, conducted with Latino, Chinese and Anglo-American cancer patients in a large, public, west-coast clinic, describes constraints on the informed consent process in a multicultural setting, including language barriers, the clinical environment, control in decision making, and conflicting desired health outcomes for health care providers and patients, and suggests some implications for nursing practice.

Patient Participation in Decision Making at the End of Life as Seen by a Close Relative

“…Dialogue is a way of supporting people's autonomy so that they can make their own choices. 16,33 A dialogue between the actors in the decision-making process seems to be the central factor in the form of participation that can most nearly be characterized as co-determination. 22,34,35 Co-determination is characterized by dialogue, collaboration and solicitude for one another on the part of all the actors.…”

“…This possibility seems to be context-dependent and affected by many factors such as the dying patient' personality, the social network, the availability of different forms of care, cultural values, and the extent to which nurses and other caregivers can and want to support the wishes of patients and relatives in the decision-making process. 13,16,17,[37][38][39] Being able to participate in decisions, even when dying, will greatly affect the patient's self-perception and his or her quality of life during the final stage of life. 1 There is much that indicates an increased demand for autonomy and participation, as well as for more involvement by relatives, in terminal care.…”

Linguistic Minorities in Canada and Health

“…Or, il ne peut y avoir de consentement éclairé sans une communication ouverte et fréquente. Quand le patient et l'intervenant ne parlent pas la même langue, il surgit immédiate-ment une barrière qui empêche le patient de s'informer complètement sur sa situation et les choix qui s'offrent à lui (Barnes et al, 1998). Dans de nombreux cas où le patient donne son consentement, il le fait sans comprendre toutes les implications de l'intervention.…”

Responding to family requests for nondisclosure: The impact of oncologists′ cultural background

“…[1][2][3][4] Consequently, Western medical practice promotes open and free communication with patients such that they are fully aware of their illness and treatment, their queries are addressed and patients are encouraged and supported to be involved in medical decision-making. However, variations in patient-doctor preferences, especially in multicultural societies, suggest a discrepancy between doctors' and patients' attitudes towards cancer disclosure, communication styles and medical decision-making.…”