PubMed · 10177832
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D Foltz-Gray. 1998. Breaking the language barrier.. https://pubmed.ncbi.nlm.nih.gov/10177832/
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UNLABELLED: Communicating "bad news" to patients and their families can be difficult for physicians. OBJECTIVE: This qualitative study aimed to examine residents' perceptions of barriers to delivering bad news to patients and their family members. DESIGN: Two focus groups consisting of first- and second-year medical and surgical residents were conducted to explore residents' perceptions of the bad news delivery process. The grounded theory approach was used to identify common themes and concepts, which included: (1) guidelines to delivering bad news, (2) obstacles to delivering bad news and (3) residents' needs. SETTING: McMaster University, Hamilton, Ontario, Canada. SUBJECTS: First- and second-year residents. RESULTS: Residents were able to identify several guidelines important to communicating the bad news to patients and their family members. However, residents also discussed the barriers that prevented these guidelines from being implemented in day-to-day practice. Specifically, lack of emotional support from health professionals, available time as well as their own personal fears about the delivery process prevented them from being effective in their roles. Residents relayed the need for increased focus on communication skills and frequent feedback with specific emphasis on the delivery of bad news. The residents in our study also stressed the importance of processing their own feelings regarding the delivery process with staff. CONCLUSIONS: Although most residents realize important guidelines in the delivery of bad news, their own fears, a general lack of supervisory support and time constraints form barriers to their effective interaction with patients.
Under-representation of ethnic minorities at drug treatment services represents under-utilisation rather than a lower need. To explore barriers to drug treatment among ethnic communities we undertook a comprehensive review of international and Australian literature to identify problems their members experience upon the discovery of illicit drug use in their community, how drug treatment is addressed and challenges for improved drug treatment outcomes. The concepts and themes derived from the literature were then compared with our research findings from key informant interviews and consultations with non-illicit drug-using spokespersons from eight ethnic communities in Victoria, Australia. Intense shame and loss of face linked to illicit drug use was common in ethnic communities and as a consequence seeking help for drug treatment was fraught with difficulties. Accessing drug treatment services often occurred following a crisis, but a sense of despair and confusion often prevailed owing to a lack of knowledge of available assistance. Even when treatment services were accessed most key informants and ethnic communities viewed them as culturally insensitive, inflexible and with language barriers that obstructed the flow of effective information. Understanding of the ethnic family ethos was of pivotal importance but frequently ignored by treatment services, contributing to the exclusion of ethnic communities from appropriate assistance. Ethnic communities need to be assisted to participate in drug issue discussions and community development strategies in order for their utilisation of drug treatment services to be improved.
It is estimated that in the next century nearly half of the clientele seeking mental health services will be members of ethnic minority groups. Hispanics are the most rapidly growing population in the United States, and epidemiological evidence suggests that they present higher levels of psychiatric symptomatology and prevalence rates of disorder compared with other ethnic groups. Despite the unprecedented recognition of cultural considerations found in DSM-IV for rendering a psychiatric diagnosis, there is still surprisingly little empirical research examining cultural and linguistic factors influencing the diagnostic process. This article critically reviews this research and considers process variables that can inform social workers' culturally sensitive diagnosis of Hispanics.