GP Clinic and its staff - Essay Example

? Case Study Introduction The staff of a GP Clinic has noticed that women from ethnic minority groups of SouthAsian origin are not taking advantage of preventative services, such as screening for cancers. Breast cancer among this group of women is presented in advanced stages and the delay in presentation is a matter of concern to many health care professionals. There are many factors that can influence persons’ perception and treatment to any type on cancer but in western countries a common trend is realized in women from minority groups. It was initially thought that aspects of health care insurance and poverty prevalence are the main factors influencing access to health care but recent studies have shown that cultural influences play a major part in some ethnic groups. Cultural attitudes toward breast cancer preventive behaviors as screening tests, perception of modesty, lack of awareness and hence encouragement by family members and physicians are the major barriers to women’s uptake of breast cancer screening (Rashidi & Rajaram, 2000). Healthcare providers face numerous challenges when working with patients from varied cultures. While supervisors and employees work with different co-workers and clients, healthcare providers judgements and decisions they make will ultimately impact the lives of patients and that of their future. This report tries to identify factors that are barriers to breast cancer screening among Asian women (Rashidi & Rajaram, 2000). Cultural Implications to Breast Cancer among Asian Women Culture and its beliefs and practices contribute to the difficulties which draw attention to understanding some of the severe illnesses within our health centres e.g. cancer, its preventative measures as self-examination, breast screening etc. which hinder some women from minority groups such as in South Asian regions from accessing health care. A study conducted by the Centre for Disease Control showed the perception towards cancer that prevails within this special ethnic group and how it was treated by the participants. Their lack of knowledge and understanding as well as lack of immediate action to treatment of breast cancer is attributable to their cultural beliefs and practices (Petro-Nustus & Mikhail, 2002). Breast cancer has been singled out as a main contributor to deaths in women of South Asian origin. When compared to white women, there is a significantly low rate of uptake of preventative services among this group of women leading to poor survival. Such preventative services are breast screening, delayed diagnosis and the late presentation of disease. Culture encompasses the common attributes of behaviour, patterns of thought, and the beliefs and values, rules of conduct which define a particular social setting and which are passed down in a generational system through the fundamentals of everyday life i.e. food, ethnicity, language, religion or faith, as well as relationships. However, culture assumes particular implications in a multi-faceted setting, providing some default standards of the dominant white group and this may not apply uniformly across the ethnic groups (Rashidi & Rajaram, 2000). It was realized that they are not aware of the severity of this illness and the urgency that is required in seeking medical intervention. This revelation advocates for the necessity to address cultural aspects of disease presentation and the access to health across minority groups because of grave perpetuating effects. Other factors that influence the attitudes of groups of certain origins toward cancer and other illnesses are level of education and socio-economic factors. The poor uptake of preventive breast screening programmes and the eventual delayed presentation of cancer has led to late stages of disease at diagnosis. Breast cancer awareness is therefore vital and promotion of screening acceptance among the women of South Asian (SA) origins in the UK (Hisham & Yip, 2004). The detected mass of tumor at presentation is much bigger, which is either localized or metastatic in comparison to those reported in Western studies whereby 75% of cases present themselves in the early stages. This delay in presentation is accredited to the socialization and cultural beliefs of the condition need for screening tests, financial implications, and influences of Eastern medicine (Petro-Nustus & Mikhail, 2002). Clinicians who are not aware of how culture influences ones uptake or acceptance of health care services may miss out on the vital medical implications and may also unintentionally intensify an already weak curative relationship. Healthcare professionals need to be equipped with cultural competency training so that they can better serve the needs of their patients. For instance, during intake of patients at one psychiatric hospital, a physician noticed that an Asian woman refused to make eye contact with him. The health care provider was not sure if he was dealing with a mental illness case (Hisham & Yip, 2004). Asian culture interprets health in a more holistic form than the Western culture. It is not only a physical thing, but also social, environmental and spiritual. The balance and harmony of counteracting forces leads to good health. (E.g. yin and yang; Ayurveda (Indian) medicine). Fatal events are viewed differently and it can mean a punishment or a curse from spirits for wrong doings in past or present lives. Traditional healing among them involves herbal alternatives, as well as acupuncture practices that are meant to restore flow of chi i.e. the life force in everything. Since Asian culture is hierarchical, the primary decision makers are mainly males who are older. Also, Asians may not express their differences or lack of understanding openly (Jarvandi, Harirchi, Kazemnejad & Montazeri, 2002). Many Asian women misunderstand the concept of preventive behaviors. Barriers to breast Cancer Screening The barriers to the uptake of preventative habits of health care among Asian women can be discussed in several categories: knowledge, psychosocial, and socio demographic factors (Abdulah & Leung 2000). i. Knowledge Factors Most women of Asian origin misunderstand the norm of preventing diseases and that it is recommended periodically. Such prevention behaviors are such as self examination and breast cancer screening (BCS). Education levels have no impact on this awareness. Studies have shown that full-time housewives were more likely to have heard and gone for mammography screening than the educated non-housewives majority. This trend was attributed to media exposure via the women’ lifestyle’s programs either on televised media or in women’s magazines. Media provides an avenue for breast cancer information and may be seen to improve the women’s knowledge that allows them to imitate the recommendations given toward prevention (Abdulah & Leung 2000). ii. Psychosocial factors ‘‘No need for a breast exam’’ as echoed by many Asian women who have been interviewed means that they will not take up a breast exam until they experienced any pressing symptoms. This perception makes them not realize the fact that by the time the signs are revealed, the disease will be advanced and treatment may be more difficult. An interesting research found that some women strongly assume that they would not have breast cancer as long as they breastfed their children! Fear, as well as denial may be attributed to delays in seeking medical care (Smith, R, Ute S, Maira C et al 2006). According to the health belief model (HBM), women who perform breast self examination (BSE) and go on to do a mammogram are those who are aware and believe that they are vulnerable to this disease and that it is a serious condition. Similarly, women who distinguish the more benefits of prevention and fewer barriers from BSE and mammography are more likely to use breast cancer screening behaviors. Also, the more higher the class the more the women who will be more confident in taking steps to detect abnormal lumps and more motivated to uphold their wellness therefore are more likely to perform BSE and have mammography (Jarvandi, Harirchi, Kazemnejad & Montazeri, 2002). The model places six factors as most important to determining preventive health behavior: (a) Seriousness: the belief in personal injury/harm of the condition, (b) Benefits: perceived positive attributes of an action (breast screening/BSE, (c) Susceptibility: vulnerability to or subjective risk of a health condition, (d) Barriers: negative aspects related to an action that one thinks may happen (e) Confidence: the belief that one can influence the outcome of something by exercising proper behavior and (f) Health motivation: beliefs and behaviors related to the state of general concern about health. Bodily experiences as perceived by the Asian culture make it indiscernible and kept on low tones. Women have always occupied a lower position, and this makes it hard for them to make individual health care choices Therefore, women’s health problems tend to be regarded as trivial. In Asian traditional culture, bodily experiences are taboo to women. They are rarely talked about even among themselves. Menopausal transitions in senior mothers are kept private as they rarely discuss the experiences with their daughters. Teenage girls also learn very little about menstruation at menarche (Smith, R, Ute S, Maira C et al 2006). Taking into consideration their conservative and traditional attitudes toward bodily exposure, it is logical to understand why Asian women are reluctant to show their breasts to others, including to health care practitioners. Furthermore, they are also hesitant to visit a clinic for further check-up when they find a lump in their breasts. They delay the check-up until later when the lump becomes serious in terms of discharge, hardness, or pain while at the same time hoping the lump would disappear soon. Delay in screening is also contributed by fear of the outcomes of the test (Straughan & Seow, 2000). iii. Socio-Demographic Factors Factors such as higher education levels, employment, married status, and young age but not ethnicity, are predictors of performance of BSE. If the social support network, i.e. family, employers, colleagues in the workplace, and friends, can be improved through accessible and relevant health education campaigns, then a more adaptive approach to preventive health care will suffice. Women with health insurance are more likely than other women to undergo mammography and this shows that health costs is a factors that can determine the access of many women to quality health care (Abdulah & Leung 2000). Interventions Asian women’s acceptance and participation in breast cancer screening and testing (BCST) needs to be promoted. Health care providers should be on the forefront to empower them by providing adequate information on BCST. Equipped with complete more accurate information, women may derive the motivation to participate in BCST rather than hoping that they would not have breast cancer because they do not have symptoms, had breastfed, or do not have a family history (Rashidi & Rajaram, 2000). Health care providers should exercise empathy by considering a woman’s feelings about BCST including clinical breast exams and mammography. This can only happen in a setting where the health care professionals have undertaken cultural competency training. When a physician in most cases is a male, the women feel uncomfortable during BCST coupled with lack of information which renders the process difficult. Female attitudes toward male physicians should be put in perspective by the health care providers when a woman comes for BCST, and make arrangements to minimize their negative feelings. Procedures for BCST should be adequately explained to the women, and provided with room to exercise their curiosity in a familiar environment via question and answer sessions (Juon, Shankar et al 2004). Public health agencies and institutions, health care professionals, and minority communities should come together to reduce disparities. Increasing the early detection of cancer, promotion of healthy lifestyles and intensifying the access to health care will help close the gap of inequalities in cancer among minorities. The media is an important source of breast cancer information for women and could improve women’s knowledge about breast cancer and breast cancer screening (Juon, Shankar et al 2004). The patriarchal effect that impacts on women’s health choices should be addressed by the government and other health institutions. This should be raised among health practitioners as well as among ethnic minority groups by use of mass media, brochures, and posters. Consciousness-raising may make health care providers to recognize cultural differences in women’s attitudes toward BCST (Lee, Im et al, 2004). Efforts to empower health care providers with cultural education, particularly to physicians, should stress the importance of screening practices by referral and the importance of being enthusiastic when making the referral. This makes them less anxious and in staying positive toward treatment. However, these are often expensive and unless they are specifically targeted at relevant segments of the population, they are not very effective. Another more effective method would be to invoke the power of informal social support in the promotion of health screening behavior (Juon, Shankar et al 2004). Conclusion Cultural attitudes toward breast cancer preventive behaviors as screening tests, perception of modesty, lack of awareness and hence encouragement by family members and physicians are the major barriers to the uptake of breast cancer screening among South Asian women. This poses extra challenges to Healthcare Professionals who are presented with terminal illness cases in a mixed and urbanized society. Thus cultural practices and customs affect cancer concerns all along the complete disease continuum: from prevention, early detection, adherence rates treatment choices, managing the side effects and their control, rehabilitation efforts, appropriate psychosocial support, survivorship issues, effective end of life care as well as hospice use (Parisa, Mirnalini et al, 2006). For practitioners, it is therefore imperative to be equipped with cultural competency in clinical practice. And since language may be a barrier, physicians should be able to have access to medical interpreters who are adequately trained or employ the use of AT& T telephone services that aid in translation when actual interpreters are not available. An education to the cancer patients should be prioritized and free or low cost referral services to cancer screening should be promoted by the physicians in the best manner possible. Male practitioners on the other hand should work hand in hand with female nurse practitioners who would be able to handle Asian women and to provide these services in a friendly atmosphere. The government on the whole should promote informative services by use of ethnic media in form of televised programs, newspapers and radio so as to reach as many minority groups as possible. 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