Turkish or Moroccan patient does not want to be informed about everything

Dutch care professionals and Turkish and Moroccan patients with cancer and their relatives often have different ideas about the communication on diagnosis, prognosis and treatment, as is shown in a publication by researchers of NIVEL, Pharos and the University of Amsterdam in BMC Palliative Care.

In the Netherlands, health care professionals have to inform patients on the diagnosis, treatment and prognosis, even when patients cannot be cured. However, they have to consider what patients want to know. In patients of Turkish or Moroccan origin who cannot speak Dutch, doctors or nurses often consult a relative who acts as an interpreter. The decision making concerns all family members, with the interpreting son or daughter representing the patient. The family often strives to curative treatment of the patient, even when he cannot be cured. They may feel strengthened in this by their religion. Often, they want to protect the patient from the bad news and do not translate everything.

Two worlds
Dutch carers and Turkish or Moroccan families often disagree about what good care is, how to talk about it and who is going to make the decisions. When Dutch professionals do impose “the Dutch way”, the family might retreat. Also, the professional might leave it up to the family too much. Both ways may result in less good care. Communication and decision making in palliative care for these patients have been investigated in a cooperation project of the University of Amsterdam, Pharos and NIVEL, financed by ZonMw.

Looking beyond the Dutch traditional idea
Researcher Fuusje de Graaff: “The key to the best possible care is decision making in cooperation with all parties involved. Health care professionals have to find a way by communicating with both patient and family. Some professionals can empathize with the communication needs of the different parties involved, they can abandon the Dutch idea of direct communication between doctor/nurse and patient: they can take into account the role the family plays. Especially older and more experienced doctors and nurses seem to be inclined to follow the family’s wishes. For example, they explain the way it goes in the Netherlands or use an interpreter at an early stage, especially to be able to find out what the patient wants to know and what his wishes are. It is very important to connect with both patient and family.”

Research
In 33 cases, 83 people involved have been interviewed for this qualitative study: 6 patients, 30 family members and 47 health care professionals.