Shared Decision-Making Tool
An individual who wishes to provide culturally sensitive health care must first become aware of the influence of his or her own culture(s) on personal beliefs. Achievement of self-awareness allows an exploration of the beliefs and culture(s) of a patient. Sensitive and thoughtful communication avoids stereotyping (conforming to a fixed or general pattern, often oversimplifying with prejudice or uncritical judgment) and allows the physician to learn about the patient’s beliefs.
The LEARN model was developed to facilitate communication between a patient and clinician and to enhance the understanding of illness. The hope is that by use of this model, the practitioner and the patient will reach a mutually acceptable and culturally sensitive treatment.
L isten with empathy (HL: Empathy - experiencing the feelings and thoughts of another; as contrasted with sympathy - sharing the feelings of another - and apathy - lack of feeling.)
E xplain your perceptions of the problem
A cknowledge and discuss the differences and similarities between your viewpoints and those of the patient. The critical aspect is to demonstrate respect for the patient’s viewpoint
R ecommend treatment (as opposed to “order” treatment)
N egotiate treatment
Examples:
Listen: Do not be afraid to ask questions
- What do you call your illness? Is it an illness?
- What do you think caused it?
- Why did it start when it did?
- What does your illness do to you? How does it work?
- How severe is it? Will it have a short or long course?
- What do you fear most about this illness?
- What are the main problems that your illness has caused for you?
- What is the normal treatment for this illness? What are you expected to do when you have this illness?
- What do you hope to receive from treatment?
(Adapted from “Kleinman's Tool to Elicit Health Beliefs in Clinical Encounters” at: http://www.diversityrx.org/HTML/MOCPT3.htm)
Explain your perceptions of the problem
- answer the Kleinman questions yourself
- “In Western medicine we call what you have…”
- Explain your terms in their words (Ex: What you refer to “twitching and drooling” is what we would refer to as a “seizure”)? “When Johnny is ‘twitching and drooling,’ he is having what I would call a seizure, which is. . .” ?
Acknowledge and discuss the differences and similarities
- use the patient’s own words whenever possible, do not talk solely in “doctor-speak”
- use what you have learned from them and connect creatively (Ex: if your patient describes an “imbalance” or an “invasion,” find a way of explaining the Western medical etiology as in imbalance or an invasion.
Recommend treatment
- recommend what you would use for treatment and why
- recommend some or all of their traditional treatments if possible (need to be knowledgeable about the traditional treatments to make sure they are not harmful nor that there would be any interactions with your recommended treatment)
Negotiate treatment
- does the patient and family comfortable with your recommendation? Do they agree with your recommendation?
- do any parts of the Western medical treatment interfere with their beliefs?
- is there anyone else they would like you to talk to?
Use of interviewing models, such as LEARN, invite patients to participate with physicians in the understanding of illness etiology and in the formulation of treatment plans, essential to a strong doctor patient relationship.
Berlin EA, Fowkes WC. A teaching framework for cross-cultural health care. West J Med. 1983: 139(6):934.
http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1011028&blobtype=pdf
Bigby J: Cross Cultural Medicine. Beyond Culture: Strategies for Caring for Patients from Diverse Racial, Ethnic, and Cultural Groups. 2003, Philadelphia: American College of Physicians-American Society of Internal Medicine. 2003.