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Original article

Vol. 152 No. 3738 (2022)

A national survey of Swiss paediatric oncology care providers’ cross-cultural competences

  • Milenko Rakic
  • Heinz Hengartner
  • Sonja Lüer
  • Katrin Scheinemann
  • Bernice S. Elger
  • Michael Rost
DOI
https://doi.org/10.4414/SMW.2022.w30223
Cite this as:
Swiss Med Wkly. 2022;152:w30223
Published
15.09.2022

Summary

BACKGROUND AND PURPOSE: Culturally diverse countries such as Switzerland face the challenge of providing cross-cultural competent care. Cross-cultural competent care needs an understanding of a patient's cultural context in order to provide safe and effective care. Therefore, we sought to examine cross-cultural competence of Swiss paediatric oncology care providers, and to explore their perceptions of barriers to and facilitators of cross-culturally competent care.

DESIGN AND SAMPLE: We conducted a cross-sectional study. The data collection period was three weeks. Providers were recruited through collaborators at the participating paediatric oncology centres. All occupational groups who are in direct contact with patients and involved in their care were eligible (e.g., physicians, nurses, social workers, occupational therapists and physiotherapists). Surveying providers online, we captured five subscales of their cross-cultural competence and their perceptions as to how to facilitate cross-culturally competent paediatric oncology care. We employed the Cross-Cultural Competence of Healthcare Professionals (CCCHP) questionnaire. Besides descriptive and inferential statistics, we performed content analysis.

FINDINGS: The response rate was 73.2% (n = 183/250). Analyses revealed differences in cross-cultural competence between occupational groups of paediatric oncology providers. Overall, social workers’ cross-cultural competence was higher than nurses' or occupational therapists' and physiotherapists’ cross-cultural competence. Physicians’ cross-cultural competence was higher than nurses (with no statistically significant difference identified between physicians, occupational therapists and physiotherapists). Furthermore, our results suggest noteworthy differences among the four main occupational groups on the five CCCHP subscales. Physicians and social workers declared more positive attitudes than nurses; occupational therapists and physiotherapists reported lower skills than the other three groups; social workers scored higher on the emotions and empathy subscale than the other three groups; physicians were more knowledgeable and aware than nurses. Most frequently mentioned barriers were: language barriers (68.5%), different culture and values (19.2%), different illness understanding (9.2%). Most frequently mentioned facilitators were: professional translators (47.2%), continuous training (20.8%), professional cultural mediators (8.8%).

CONCLUSIONS/IMPLICATIONS: Trainings and interventions are widely considered a principal strategy to advance providers’ cross-cultural competence. Our findings of differences in cross-cultural competence among occupational groups further underpin the need to adapt training programmes and interventions to the respective occupational group and the respective dimension(s) of cross-cultural competence. In addition, professional translators and cultural mediators should be used. Lastly, reciprocal supervision and the promotion of multidisciplinary teams is crucial to enable oncology care providers to learn from each other and this exchange could also help to reduce some of the differences between the various occupational groups.

References

  1. Swiss Federal Statistical Office. Foreign population. 2020; Available from: https://www.bfs.admin.ch/bfs/en/home/statistics/population/migration-integration/foreign.html
  2. Swiss Federal Statistical Office. Die Bevölkerung der Schweiz 2017. 2018.
  3. Swiss Federal Statistical Office. Statistischer Bericht zur Integration der Bevölkerung mit Migrationshintergrund. 2017.
  4. Swiss Federal Statistical Office. Bevölkerung nach Migrationsstatus 2017. 2018.
  5. Swiss Childhood Cancer Registry. Annual Report 2017/2018. 2019.
  6. Swiss Federal Office of Public Health. National Programme on Migration and Health - 2008–2013 results and priorities for 2014–2017. 2013.
  7. Jaeger FN, Hossain M, Kiss L, Zimmerman C. The health of migrant children in Switzerland. Int J Public Health. 2012 Aug;57(4):659–71. https://doi.org/10.1007/s00038-012-0375-8
  8. Gehri M et al. Primary care for the migrant population in Switzerland: a paediatric focus. Paediatrica. 2016;27(Special issue: migrants):9-15.
  9. Rost M, et al. Barriers to Palliative Care in Pediatric Oncology in Switzerland: A Focus Group Study. J Pediatr Oncol Nurs. Accepted 2019.
  10. Campinha-Bacote J. The Process of Cultural Competence in the Delivery of Healthcare Services: a model of care. J Transcult Nurs. 2002 Jul;13(3):181–4. https://doi.org/10.1177/10459602013003003
  11. Stefanenko T, Kupavskaya A. Developing Cross-cultural Competence, in Encyclopedia of the Sciences of Learning, N.M. Seel, Editor. 2012, Springer US: Boston, MA. p. 941-944.
  12. Schim SM, Doorenbos AZ. A three-dimensional model of cultural congruence: framework for intervention. J Soc Work End Life Palliat Care. 2010;6(3-4):256–70. https://doi.org/10.1080/15524256.2010.529023
  13. Mack JW, Uno H, Twist CJ, Bagatell R, Rosenberg AR, Marachelian A, et al. Racial and Ethnic Differences in Communication and Care for Children With Advanced Cancer. J Pain Symptom Manage. 2020 Oct;60(4):782–9. https://doi.org/10.1016/j.jpainsymman.2020.04.020
  14. Mitchison D, Butow P, Sze M, Aldridge L, Hui R, Vardy J, et al. Prognostic communication preferences of migrant patients and their relatives. Psychooncology. 2012 May;21(5):496–504. https://doi.org/10.1002/pon.1923
  15. Wiener L, McConnell DG, Latella L, Ludi E. Cultural and religious considerations in pediatric palliative care. Palliat Support Care. 2013 Feb;11(1):47–67. https://doi.org/10.1017/S1478951511001027
  16. Weissman JS, Betancourt J, Campbell EG, Park ER, Kim M, Clarridge B, et al. Resident physicians’ preparedness to provide cross-cultural care. JAMA. 2005 Sep;294(9):1058–67. https://doi.org/10.1001/jama.294.9.1058
  17. De Clercq E, Rost M, Pacurari N, Elger BS, Wangmo T. Aligning guidelines and medical practice: literature review on pediatric palliative care guidelines. Palliat Support Care. 2017 Aug;15(4):474–89. https://doi.org/10.1017/S1478951516000882
  18. Haines ER, Frost AC, Kane HL, Rokoske FS. Barriers to accessing palliative care for pediatric patients with cancer: A review of the literature. Cancer. 2018 Jun;124(11):2278–88. https://doi.org/10.1002/cncr.31265
  19. Cheng BT, Rost M, De Clercq E, Arnold L, Elger BS, Wangmo T. Palliative care initiation in pediatric oncology patients: A systematic review. Cancer Med. 2019 Jan;8(1):3–12. https://doi.org/10.1002/cam4.1907
  20. Suurmond J, Lieveld A, van de Wetering M, Schouten-van Meeteren AY. Towards culturally competent paediatric oncology care. A qualitative study from the perspective of care providers. Eur J Cancer Care (Engl). 2017 Nov;26(6):e12680. https://doi.org/10.1111/ecc.12680
  21. Doorenbos AZ, Morris AM, Haozous EA, Harris H, Flum DR, Doorenbos AZ, et al. Assessing Cultural Competence Among Oncology Surgeons. J Oncol Pract. 2016 Jan;12(1):61–2. https://doi.org/10.1200/JOP.2015.006932
  22. Nemeth, C. and E. Pochobradsky. Hospiz- und Palliativversorgung für Kinder, Jugendliche und junge Erwachsene. 2013.
  23. EAPC Taskforce for Palliative Care in Children. Palliative Care for Infants, Children and Young People. The Facts. 2009.
  24. Lee RM, Titzmann PF, Jugert P. Towards a More Dynamic Perspective on Acculturation Research, in Youth in multicultural societies: New directions for future research and interventions, P.F. Titzmann and P. Jugert, Editors. in press, Psychology Press.
  25. United Nations. Universal Declaration of Human Rights. 1948.
  26. Luna F. Elucidating the Concept of Vulnerability: Layers Not Labels. Int J Fem Approaches Bioeth. 2009;2(1):121–39. https://doi.org/10.3138/ijfab.2.1.121
  27. Federal Office of Public Health (FOPH). Swiss Hospitals for Equity. 2019; Available from: https://www.bag.admin.ch/bag/en/home/strategie-und-politik/nationale-gesundheitsstrategien/gesundheitliche-chancengleichheit/chancengleichheit-in-der-gesundheitsversorgung/swiss-hospitals-for-equity.html
  28. Bernhard G, Knibbe RA, von Wolff A, Dingoyan D, Schulz H, Mösko M. Development and Psychometric Evaluation of an Instrument to Assess Cross-Cultural Competence of Healthcare Professionals (CCCHP). PLoS One. 2015 Dec;10(12):e0144049. https://doi.org/10.1371/journal.pone.0144049
  29. Universitätsklinikum Hamburg-Eppendorf (UKE). Fragebogen zur Erhebung Interkultureller Kompetenz in der Gesundheitsversorgung (CCCHP-27).
  30. Hietapakka L, Elovainio M, Wesolowska K, Aalto AM, Kaihlanen AM, Sinervo T, et al. Testing the psychometric properties of the Finnish version of the cross-cultural competence instrument of healthcare professionals (CCCHP). BMC Health Serv Res. 2019 May;19(1):294. https://doi.org/10.1186/s12913-019-4105-2
  31. Mayring, P., Qualitative content analysis: theoretical foundation, basic procedures and software solution. 2014.
  32. Zentralarchiv für empirische Sozialforschung (ZA) & Zentrum für Umfragen, M.u.A.Z.e.V. Religiosity scale. Zusammenstellung sozialwissenschaftlicher Items und Skalen (ZIS). 2014; Available from: https://zis.gesis.org/skala/ZA-ZUMA-Religiosit%C3%A4tsskala
  33. Matsunaga M. Familywise Error in Multiple Comparisons: Disentangling a Knot through a Critique of O’Keefe’s Arguments against Alpha Adjustment. Commun Methods Meas. 2007;1(4):243–65. https://doi.org/10.1080/19312450701641409
  34. Rubin M. Do p Values Lose Their Meaning in Exploratory Analyses? It Depends How You Define the Familywise Error Rate. Rev Gen Psychol. 2017;21(3):269–75. https://doi.org/10.1037/gpr0000123
  35. Federal statistical Office. Languages - Main languages of the permanent resident population. 2020; Available from: https://www.bfs.admin.ch/bfs/en/home/statistics/population/languages-religions/languages.html
  36. Casillas A, Paroz S, Green AR, Wolff H, Weber O, Faucherre F, et al. Cultural competency of health-care providers in a Swiss University Hospital: self-assessed cross-cultural skillfulness in a cross-sectional study. BMC Med Educ. 2014 Jan;14(1):19. https://doi.org/10.1186/1472-6920-14-19
  37. Nageswara Rao AA, Warad DM, Weaver AL, Schleck CD, Rodriguez V. Cross-Cultural Medical Care Training and Education: a National Survey of Pediatric Hematology/Oncology Fellows-in-Training and Fellowship Program Directors. J Cancer Educ. 2019 Jun;34(3):478–87. https://doi.org/10.1007/s13187-018-1326-8
  38. Cunningham CT, Quan H, Hemmelgarn B, Noseworthy T, Beck CA, Dixon E, et al. Exploring physician specialist response rates to web-based surveys. BMC Med Res Methodol. 2015 Apr;15(1):32. https://doi.org/10.1186/s12874-015-0016-z
  39. Watt K, Abbott P, Reath J. Developing cultural competence in general practitioners: an integrative review of the literature. BMC Fam Pract. 2016 Nov;17(1):158. https://doi.org/10.1186/s12875-016-0560-6
  40. Hudelson P. Contextualizing cultural competence training of residents: results of a formative research study in Geneva, Switzerland. Med Teach. 2006 Aug;28(5):465–71. https://doi.org/10.1080/01421590600607567
  41. Domenig D. Transcultural change: a challenge for the public health system. Appl Nurs Res. 2004 Aug;17(3):213–5. https://doi.org/10.1016/j.apnr.2004.07.001
  42. Parrott L. Constructive Marginality: Conflicts and Dilemmas in Cultural Competence and Anti-Oppressive Practice. Soc Work Educ. 2009;28(6):617–30. https://doi.org/10.1080/02615470903027322
  43. Eche IJ, Aronowitz T. Evaluating Cultural Competence of Pediatric Oncology Nurses at a Teaching Hospital: A Pilot Study. J Pediatr Oncol Nurs. 2017 Nov/Dec;34(6):422–6. https://doi.org/10.1177/1043454217713452
  44. Dabney K, McClarin L, Romano E, Fitzgerald D, Bayne L, Oceanic P, et al. Cultural Competence in Pediatrics: Health Care Provider Knowledge, Awareness, and Skills. Int J Environ Res Public Health. 2015 Dec;13(1):ijerph13010014. https://doi.org/10.3390/ijerph13010014
  45. Jongen C, McCalman J, Bainbridge R. Health workforce cultural competency interventions: a systematic scoping review. BMC Health Serv Res. 2018 Apr;18(1):232–232. https://doi.org/10.1186/s12913-018-3001-5
  46. Rao, A.N., D. Warad, and V. Rodriguez, Cross-Cultural Care Training for Pediatric Hematology/Oncology Fellows. 2017. 13.
  47. Lachal J, Escaich M, Bouznah S, Rousselle C, De Lonlay P, Canoui P, et al. Transcultural mediation programme in a paediatric hospital in France: qualitative and quantitative study of participants’ experience and impact on hospital costs. BMJ Open. 2019 Nov;9(11):e032498. https://doi.org/10.1136/bmjopen-2019-032498
  48. Federal Office of Public Health. Migrationssensitive Palliative Care. 2016; Available from: https://www.bag.admin.ch/bag/de/home/strategie-und-politik/nationale-gesundheitsstrategien/strategie-palliative-care/sensibilisierung-zu-palliative-care/mitgrationssensitive-palliative-care.html
  49. Chun MB, Jackson DS, Lin SY, Park ER. A comparison of surgery and family medicine residents’ perceptions of cross-cultural care training. Hawaii Med J. 2010 Dec;69(12):289–93.
  50. Moleiro, C., et al., Cultural Diversity Competencies in Child and Youth Care Services in Portugal: Development of two measures and a brief training program. 2011. 33: p. 767-773.

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