A 50-year-old man comes to the office for a preventive examination. The patient is accompanied by his wife and daughter. He currently feels well and takes no medications. The patient works as an accountant at a large technology corporation. He smoked a pack of cigarettes daily for 5 years but quit 15 years ago. The patient drinks 1 or 2 alcoholic beverages per week. He emigrated from Colombia 5 years ago and is fluent in English. Physical examination is within normal limits. The provider recommends colon cancer screening, but the patient appears hesitant and states, "I don't think I really need that because I feel good right now, and I'm pretty sure I don't have cancer." Which of the following is the best next step?

Question

A 50-year-old man comes to the office for a preventive examination.  The patient is accompanied by his wife and daughter.  He currently feels well and takes no medications.  The patient works as an accountant at a large technology corporation.  He smoked a pack of cigarettes daily for 5 years but quit 15 years ago.  The patient drinks 1 or 2 alcoholic beverages per week.  He emigrated from Colombia 5 years ago and is fluent in English.  Physical examination is within normal limits.  The provider recommends colon cancer screening, but the patient appears hesitant and states, "I don't think I really need that because I feel good right now, and I'm pretty sure I don't have cancer."  Which of the following is the best next step?

Quizplus · Accepted Answer

Explanation: Significant health care disparities can undermine the health of minority and immigrant patients. Cross-cultural care improves minority health outcomes, provider-patient communication, and health care quality (eg, completing recommended cancer screening). Cross-cultural care reflects core principles of high-value care common to all populations: Patient-centeredness: understanding and aligning care with patient values and priorities Cultural sensitivity: exploring and responding to a patient's cultural perspective (eg, avoiding stereotyping or assumptions, asking questions) and understanding sociocultural influences on perceptions of health Enhanced communication: addressing language barriers (eg, use of interpreter services) and tailoring communication styles (eg, adjusting eye contact, addressing family) to patient preferences This patient is hesitant to undergo colon cancer screening, but his reasons need clarification. The clinician should engage in cross-cultural care by first understanding the patient's perceptions and beliefs about cancer and its causes. For example, non-White patients may perceive themselves as less susceptible to cancer if prevention messaging (eg, television advertising) primarily features images of White American communities. In addition, patients may associate screening with fear (eg, "tempting fate" when symptoms are absent) or stigma (eg, relation of cervical cancer to sexual activity). Understanding the patient's perspective will enable the clinician to provide more meaningful counseling, which increases likelihood of screening acceptability and completion. (Choice A) Patient perceptions about disease prevention and causation may extend beyond scientific paradigms (eg, spirituality, nature). The patient's perspective on disease must first be understood before proceeding with scientific explanations. (Choice B) Beginning counseling by explaining that the patient's cancer risk is increased by his smoking history can exacerbate fears about screening and is less effective as a first step compared to identifying the patient's understanding of cancer causes. (Choice C) Family-centered discussions can be useful in complex situations (eg, cancer treatment); certain cultures may also value family involvement. However, the provider should first work with the patient directly and identify his preferences. (Choice E) Culturally inclusive materials can promote cross-cultural care but should be used as an adjunct to active, patient-centered discussion. Offering materials may be ineffective if this patient perceives screening to be unnecessary; therefore, soliciting patient perspectives is a better first step. Educational objective: Cross-cultural care is patient-centered (reflects patient values) and culturally sensitive (responds to a patient's sociocultural paradigm). It involves first exploring individual health perceptions (eg, cancer causes), allowing tailoring of further counseling (eg, cancer screening). References: Addressing disparities in cancer screening among U.S. immigrants: progress and opportunities. (http://www.ncbi.nlm.nih.gov/pubmed/32132119)

A 50-Year-Old Man Comes to the Office for a Preventive