Clinical Contributions

Exceeding Patients' Expectations for Culturally Competent Care
By Kristene Cristobal, MS; Nilda Chong, MD, DrPH, MPH; Sue Tico, BA

A clinician who develops trusting, mutually cooperative relationships with patients increases patient adherence to treatment plans, patient satisfaction, and likelihood of improved health outcomes. Because culture shapes health care beliefs, health behaviors, and expectations for health care experience, understanding the role of culture can contribute to the clinician-patient relationship; and thus, to the delivery of quality care and clinical effectiveness. Culturally competent care can enhance clinician-patient communication and create an atmosphere of shared decision making.

Some important factors that influence health care beliefs and practices include place of birth, primary language spoken, immigrant status, and religious background. Questions specific to health care treatment and affected by cultural influences include:

• What has the patient already done?
• Who does the patient trust with primary health care: a primary care physician, a traditional healer, or an osteopathic doctor?
• What are the patient's health care beliefs, expectations of the clinician and of the treatment, and desires/preferences for treatment?

How Does a Clinician Obtain all this Information?
The Culturally Competent Care Pocket Card, included in this issue of The Permanente Journal, is a portable point-of-care tool that guides clinicians through a set of questions that integrate these cultural factors into a patient visit. The pocket card defines culturally competent care and suggests ways to help build culturally competent knowledge and skills. Tips include:

• How to identify the patient's linguistic needs, oral and written.
• How to elicit the patient's feelings/
  beliefs about the illness, treatments already tried, and preferences for learning approaches.
• How to create a mutually accepted treatment plan.
• How to work with interpreters.

The pocket card contains information about cultural differences in:

• communication
• religion
• folk medicine
• dietary practices
• health beliefs
• end-of-life decision making

The pocket card is an evidence-based, practical synthesis of best practices and current knowledge in culturally competent care, developed jointly by the Care Management Institute (CMI) and the Institute for Culturally Competent Care (ICCC). The National Diversity Council's culturally competent care handbooks, a resource and organizing tool for the pocket card, can be accessed online at: http://kpnet.kp.org/national/diversity.

CMI and the ICCC offer the Culturally Competent Care Pocket Card as a tool to improve the clinician-patient relationship and to exceed patients' expectations for high quality, patient-centered care.

The following is a partial bibliography for the pocket card development.

• Blackhall LJ, Murphy ST, Frank G, Michel V, Azen S. Ethnicity and attitudes toward patient autonomy. JAMA 1995 Sep 13;274(10):820-5.
• Buchwald D, Caralis PV, Gany F, et al. Caring for patients in a multicultural society. Patient Care 1994 Jun 15;28(11):105-23.
• Kleinman A, Eisenberg L, Good B. Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Ann Intern Med 1978 Feb;88(2):251-8.
• Medrano MA. An introduction to culture and cross-cultural communication in the medical encounter [lecture]. National Conference on Cultural Competence and Women's Health Curriculum, Washington, DC, 1995.
• LIVE & LEARN: a practical approach to enhance cultural competence: a workshop presented by Nicolas Carballeira, ND, MPH, Director of Policy Research, Latino Health Institute. Exchange 2001 Jun;1(3):1-2.
• Habel M. Caring for people of many cultures: working toward cultural competence [2nd of two parts]. NurseWeek 2001 Jan 22;():33-4.
• Gardenswartz L, Rowe A. Increasing cross-cultural competence in patient care: cases in point [presentation]. Kaiser Permanente 23rd Annual National Diversity Conference, November 15, 2000. Los Angeles: Gardenswartz & Rowe; [2000].
• The development of the handbooks included a broad literature review of medical and other health-related journals and state and federal publications on health.

To obtain additional copies, please contact us at the CMI Product Information Line: 510-271-6426 or CMIproducts@pkc.kp.org
The National Diversity Hotline: 510-271-6663.