Cultural Sensitivity in Healthcare Decision-Making

Vietnamese Cultural Considerations

• In Vietnam, the eldest male is often the family spokesman, and older women may also have significant influence.
• Decisions are often made by the eldest male, but if the patient does not want to make their own medical decisions, a Durable Power of Attorney for healthcare needs to be prepared.
• Removal of life support may require extensive family discussion, placing the responsibility for the decision on the entire family rather than on one individual.

Respect for Elders and Authority

• Patients may have a deep respect for elders and people with authority, which may lead them to be reluctant to say "no" to a doctor or healthcare provider.
• Asking about "Do Not Resuscitate" orders and documenting these wishes can give patients and their families a sense of security.

Views on Pain, Illness, and Treatment

• Patients may accept pain and illness in a stoic manner, motivated by a strong desire to go home.
• Patients may mask their pain, and surgery may be seen as a treatment of last resort.
• Blood loss, including blood drawn for lab tests, may be believed to make patients sicker.

Vietnamese Rituals and Religious Practices

• Most Vietnamese are Buddhist, with other religious preferences including Catholic, Evangelical Protestant, and Chinese Confucianism.
• Patients may call a monk to give blessings, chant, and create an altar for prayer.
• Catholic patients may ask for a priest for last rites at the end of life.

Importance of Food and Mourning

• Food is considered important for health in Vietnamese culture, and family members may force food on patients when they are ill.
• White is the color of mourning in Vietnamese culture.

Effective Communication

• Ask questions before entering the room to ensure a good time to talk, assess the patient's and family's needs, and avoid overwhelming them with information.
• Use active attentive listening, nodding, and reflective statements to encourage communication.
• Avoid giving advice unless asked, and build on the patient's responses to guide the conversation.

SPIKES Protocol

• Give information in small amounts, using the "warning shot" principle to facilitate understanding.
• Check understanding frequently and reinforce with plain language.
• Emphasize empathic responses to the patient's emotions and reactions.

Palliative Care and End of Life Care

• Managing physical and psychological symptoms alleviates distress and suffering.
• Dyspnea is a common symptom in oncological patients, causing multidimensional distress and affecting quality of life.
• Dyspnea can be caused by various factors, including direct tumor effects, treatment-related effects, cardiovascular disease, pulmonary disease, and anxiety.

Pathophysiology of Dyspnea

• Respiratory control involves input from various receptors in the chest wall, airways, and chemoreceptors in blood vessels.
• Dyspnea arises from the awareness of a respiratory supply-and-demand mismatch.

This quiz assesses your understanding of cultural nuances in healthcare decision-making, including the role of family members and the importance of communication.