Cultural mediation in cancer diagnosis and end of life decision‐making: The experience of Aboriginal patients in Canada

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Abstract
This paper examines the process of cultural mediation in end of life care of Aboriginal people in urban hospitals. It summarises interview and observational data on the experience of ten Canadians from First Nations communities who were receiving palliative care for renal cancers and other forms of end stage renal disease. Parallel interviews were conducted with members in their families, their health care providers and Aboriginal health interpreters. Older informants and family members asserted cultural values prohibiting direct communication involving terminal prognosis or palliative care options. Their perspective appeared to reflect traditional prohibitions against ‘telling bad news’ related to beliefs that references to mortality had the capacity to create reality. Younger patients favoured more explicit communication about terminal prognosis and wanted to know what palliative care options were available. Interviews were conducted with eight interpreters involved in palliative care work. Interpreters played a major role, not only in providing linguistic services, but also in mediating conflicting cultural and ethical values guiding end of life decisions. Interpreters described situations in which they had been asked to ‘broker’ communication between terminally ill patients, family members and caregivers. Often each group held conflicting values about the need for truth‐telling and maintenance of autonomy. Interpreters expressed concern over their lack of formal power and complained that time constraints and role ambiguity restricted them to providing ‘reductionist’ or decontextualised explanations of diagnosis and treatment options. These messages often blurred fundamental differences in the value perspective of each participant in end of life decisions.