The Impact of Faith & Culture on Medical Decision Making & Advance Care Planning Rev. James Kraft, M.Th. jkraft2@hfhs.org or kraftjim@yahoo.com Conflict of Interest No conflict to report Off Label Use Disclaimers: Off label use of any products will not be discussed Commercial Support There is no commercial support for this program 1
Objectives Value of addressing spiritual/religious and cultural needs of individuals considering future medical decisions How does culture/faith affect Advance Care Planning? Identify potential barriers with non western cultures and various faith groups Culture The values, norms, and traditions that affect how individuals of a particular group perceive, think, interact, behave, and make judgments about their world. Ethnicity, National Origin & Race Communities Workplace Families 2
Spirituality Spirituality is a dynamic and intrinsic aspect of humanity through which persons seek ultimate meaning, purpose, and transcendence, and experience relationship to self, family, others, community, society, nature, and the significant or sacred. Who we see ourselves as Family Community Nature Religion Puchalski, Vitillo, Hull, Reller, Improving the Spiritual Dimension of Whole Person Care: Reaching National and International Consensus, Journal of Palliative Medicine June, 2014 Religion Atheism Taoism Roman Catholic Paganism Sikhism Orthodox Judaism SUNNI MUSLIM Eastern Orthodox Protestant Alaska Native REFORMED JUDAISM Southern Baptist SHINTO Confucianism American Indian Buddhism Hasidic WICCAN Jehovah Unitarianis Witness m Religion involves beliefs, practices, and rituals related to the sacred, where the sacred is that which relates to the mystical, supernatural, or God. Religion is rooted in an established tradition that arises out of a group of people with common beliefs and practices concerning the sacred. 3
Religious and Spiritual When Hospitalized, older patients described their spiritual paradigm as: Religious and Spiritual 88% Spiritual, not Religious 7% Religious, not Spiritual 3% Neither 3% (H.G. Koenig, Journal of American Geriatrics, 2004) 4
America Still Believes 9 out of 10 Americans still say yes when asked, Do you believe in God? 83% of all Americans still label themselves as Christian Fastest growing religion in U.S.? More than 70% identified religion as one of the most important influences in their lives Belief systems are diverse WICCA ISLAM www.ncbi.nlm.nih.gov/pubmedhealth/pmh0032782/?report=printable When Medicine and Faith Intersect 80% of all seriously ill patients thought it appropriate to discuss their faith with their doctor 50% of non religious people thought it appropriate for their physician to inquire about their faith 91% of physicians agree that it is appropriate to discuss religious issues when the patient brings them up. HOWEVER Only 10% of physicians report doing so on a regular basis Tanenbaum Institute, Center for Interreligious Understanding 5
Cancer Study High religious copers had a six fold increase in preference for aggressive treatment at end of life than low religious copers. 3 X s more likely to actually receive some type of intensive lifeprolonging care. These patients also reported less satisfaction and a poorer quality of life (Balboni, Journal of Clinical Oncology 2007) Continued Possible reasons for such aggressive approach: Incomplete understanding of medical condition Insufficient medical knowledge. A misunderstanding of the ability of medicine to cure the patient Mistrust of medical providers in treatment recommendations being offered A religious conviction that God would heal and the patient must be kept alive until that healing occurred But 6
When Spiritual Needs Were Addressed 3X s less likely to choose aggressive care 3X s more likely to enter into Hospice Lack of Understanding = Misinterpretation Illustration Patient lacked understanding Non compliance Failure to thrive 7
Cultural Barriers to Advance Care Planning and Medical Decision Making Communication Language, Education Decision Making Protecting patient for their own good Trust/Fear History Not wanting to be found out Not wanting to challenge authority Being respectful Being direct/indirect Eye contact Touch Expressing pain Relation to authority Family hierarchy Gender relations Decision making processes Body language Perspectives on health Religious Barriers to ACP and Medical Decision Making Sanctity of life Suffering is test of faith Not wanting to Play God Believing in miracles Not knowing what their own scriptures teach Religion involves beliefs, practices, and rituals related to the sacred, where the sacred is that which relates to the mystical, supernatural, or God. Religion is rooted in an established tradition that arises out of a group of people with common beliefs and practices concerning the sacred. 8
Examples of Cultural Influence In collectivist Asian and Muslim cultures, illness is a shared family affair. Consequently, decision making is family centered and beneficence and non malfeasance play a dominate role in their ethical model, in contrast to patient autonomy in Western cultures. In several southern and eastern European countries, much of Asia and the Middle East, physicians and patients often feel that withholding medical information is more humane and ethical. In Ethiopian culture, there are fears that patients can die from the shock of bad news. Talking about or discussing death is considered bad luck to many Chinese. Questions Open and honest communication is always the best policy when it comes to patient care Strongly agree Agree Neutral Disagree Strongly disagree If we tell the patient the truth about their fatal diagnosis or prognosis, the patient will lose hope, leading to despondence, physical suffering, mental anguish and a hastened death Strongly agree Agree Neutral Disagree Strongly disagree Who s responsibility is it to manage the information and patient experience during illness Medical personnel Family 9
ROSE Thank You! 10