Discussion: Metastatic breast cancer

Margaret Schmidt, a terminally ill 60-year-old American of German descent, was
recently admitted to a hospice service and is
receiving care at home. Diagnosed with
metastatic breast cancer, Margaret’s prognosis
is less than 6 months. Margaret’s cancer
has metastasized to her ribs and liver and
often causes intense pa
in. Although Margaret
speaks freely of her impending death, her family
has expressed their discomfort at her
decision to secure hospice care.
Over the last 10 years, Margaret, a nurs
e, has practiced homeopathy (for herself
and others) and consults frequently with a
medical intuitionist. She follows the medical
intuitionist’s recommendations to attenuate
her symptoms but avoids, when she can, the
traditional cancer pain
–management therapies.
Medical staff and her family have entere
d into continuous discussions with her
about her lack of acceptance of traditiona
l medical approaches. Margaret remains
unconvinced of their value within her scheme
of care. Margaret main
tains a strong belief
in an afterlife, believing that
she will be reunited with
her husband. Margaret meditates
daily, calling upon her spiritual guides and angels for strength and peace in the dying
process. She often asks those around
her to join her during this time.
Study Questions
1.
What experiences have you had with patients of German descent?
2.
How does Margaret’s German ancest Discussion: Metastatic breast cancer
ry mold her beliefs about medical
treatment?

3.
What Western medicine concepts
complicate the staff and family’s
understanding of Margaret’s self
-prescribed medical regimen?
4.
How do you, as a health-care prof
essional, feel about the use of
homeopathic remedies?
5.
What is your view of the use of
medical intuitionists and other non-
Western health practices?
6.
How do Margaret’s health-care c
hoices differ or match your own?
7.
How do you deal with cultural health practices unlike your own?
8.
Discuss Margaret’s desire to contro
l her life even through terminal illness.
9.
Relate Margaret’s strong spiritual beli
efs in an afterlife to her ability to
cope with her impending death.
10.
Describe a plan of care that is cultu
rally sensitive to the patient and her
family.
11.
How can your knowledge of the German American culture positively
influence health outcomes for Margaret? Discussion: Metastatic breast cancer
12.
Discuss the cultural filters you may
use as you assist Margaret in her
health-care decisions.
13.
Describe the enculturation you, as
a health-care professional, have
experienced and how this influences
your own health-care decisions.

RISH CASE STUDY
The O’Rourke family lives on a small farm in Iowa and comprises David, aged 30; his
wife, Mary, aged 29; and two children: Bridge
t, aged 7, and Michael, aged 6. Both David
and Mary are second-generation Irish. Before
purchasing their farm 5 years ago, David
sold farm equipment in Ohio. The O’R
ourkes are Catholic; Mary converted to
Catholicism when they married.
David, who works long hours outdoors, is
concerned about profitability from
his corn crop because of the unpredictable size of the harvest, and thus, his income
varies depending on the weather. Mary di
d not work outside the home because she
wanted to be with their children until they started school. However, because both
children are now school age, Mary has discus
sed with David the possibility of working
part time to supplement the family income. He
would prefer that she stay at home, but
Mary is anxious to return to the wo
rkforce and believes the timing is right.
Both David and Mary are happy with ju
st two children and do not desire more.
They use the rhythm method for family planning.
Eating a healthy breakfast is important
to the O’Rourkes. Because eggs are
readily available on the farm, they have frie
d eggs with potato bread and juice at least
four times a week. Their main meal in the
evening usually includes meat, potatoes, and
a vegetable. David enjoys a
glass of beer with dinner.
David has been a little edgy lately becau
se of his concerns about the corn crop.
He admits to having some minor chest pain, wh
ich he attributes to indigestion. His last
visit to a physician was before their marri
age. Mary knows David is concerned about
finances and believes it would help if she had a job.

Bridget and Michael spend
a lot of time outside playing and doing some minor
chores for their parents. Both children
enjoy school and are looking forward to
returning in the fall. Bridget is starting to
show concern over her appearance. She does
not like her red hair and all the freckles on he
r face. Her teacher has noted that Bridget
has trouble reading and may need glasses.
Michael wants to be a farmer like his Dad
but worries about his Da
d being tired at night. Discussion: Metastatic breast cancer
The O’Rourkes have not taken a vacati
on since they were married. They go to
the state fair in the summer, which is the extent of their trips away from home. They
are active in the church and
attend services every Sunday.
Study Questions
1. Describe the O’Rourke family st
ructure in terms of individual roles.
2. Identify two potential health problems re
lated to the O’Rourke
’s dietary practices.
3. Identify potential health-risk
factors for the O’Rourkes as a family unit and for each
family member.
4. Explain the relationship be
tween risk factors a
nd ethnicity specific
to the O’Rourke
family and their Irish heritage.
5.
Describe culturally competent health-promotion strategies for the identified risk
factors for the O’Rourke family.
6. Describe the O’Rourke family’s fertility
practices. Are they congruent with their
Irish background and religious beliefs?
7.
Describe the O’Rourke fam
ily’s communication patterns.

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