The ETHNIC(S) Mnemonic: A Clinical Tool for Ethnogeriatric Education
Fred A. Kobylarz MD, MPH
Department of Family Medicine, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey.
Search for more papers by this authorJohn M. Heath MD
Department of Family Medicine, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey.
Search for more papers by this authorAgsf
Department of Family Medicine, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey.
Search for more papers by this authorRobert C. Like MD, MS
Department of Family Medicine, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey.
Search for more papers by this authorFred A. Kobylarz MD, MPH
Department of Family Medicine, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey.
Search for more papers by this authorJohn M. Heath MD
Department of Family Medicine, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey.
Search for more papers by this authorAgsf
Department of Family Medicine, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey.
Search for more papers by this authorRobert C. Like MD, MS
Department of Family Medicine, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey.
Search for more papers by this authorAbstract
Geriatrics healthcare providers need to be aware of the effect that culture has on establishing treatment priorities, influencing adherence, and addressing end-of-life care issues for older patients and their caregivers. The mnemonic ETHNIC(S) (Explanation, Treatment, Healers, Negotiate, Intervention, Collaborate, Spirituality/Seniors) presented in this article provides a framework that practitioners can use in providing culturally appropriate geriatric care. ETHNIC(S) can serve as a clinically applicable tool for eliciting and negotiating cultural issues during healthcare encounters and as a new instructional strategy to be incorporated into ethnogeriatric curricula for all healthcare disciplines.
REFERENCES
- 1 Cohen E, Goode T. Policy Brief 1: Rationale for Cultural Competence in Primary Healthcare. Washington, DC: Georgetown University Child Development Center, The National Center for Cultural Competence, 1999.
- 2 U.S. Bureau of the Census and National Institute on Aging. Racial and Ethnic Diversity of America's Elderly Population. Profiles of America's Elderly. Washington, DC: U.S. Bureau of the Census and National Institute on Aging, 1993.
- 3 U.S. Census Bureau. Population projections of the United States by Age, Sex, Race, Hispanic Origin and Nativity, January 2000. Available at http://www.aoa.gov/minorityaccess/intro.html Accessed August 17, 2001.
- 4 Healthy People 2010. Available at http://www.health.gov/healthypeople Accessed August 17, 2001.
- 5 Lillie-Blanton M, Hoffman C. Racial and ethnic disparities in access to medical care. Med Care Res Rev 2000; 57: 5–10.
- 6 Mayberry RM, Mili F, Vaid IGM et al. Racial and ethnic differences in access to medical care. A synthesis of the literature. The Henry J. Kaiser Family Foundation. October 1999. Available at http://www.kff.org Accessed August 17, 2001.
- 7 Gornick ME. Disparities in medicare services: Potential causes, plausible, explanations, and recommendations. Minority Health Today 2001; 2: 17–30.
- 8 Goode T, Harrison S. Policy Brief 3: Cultural Competence in Primary Health Care: Partnerships for a Research Agenda. Washington, DC: Georgetown University Child Development Center, The National Center for Cultural Competence, 2000.
- 9 Davis BJ, Voegtle KH. Culturally Competent Health Care for Adolescents: A Guide for Primary Health Care Providers. Chicago, IL: American Medical Association, 1994.
- 10 Brach C, Fraser I. Can cultural competence reduce racial and ethnic health disparities? A review and conceptual model. Med Care Res Rev 2000; 57: 181–217.
- 11 Federal Register. National Standards on Culturally and Linguistically Appropriate Services in Health Care. Office of Minority Health. Vol 65:80865–80879. Washington DC: December 20, 2000. Available at http://www.omhrc.gov/clas Accessed August 17, 2001.
- 12 Federal Register. Policy Guidance on the Prohibition Against National Origin Discrimination as it Affects Persons with Limited English Proficiency. Office of Civil Rights. Vol 65:52762. Washington DC: August 30, 2000. Available at http://www.hhs.gov/ocr/lep/guide.html Accessed August 17, 2001.
- 13 The Provider's Guide to Quality and Culture. Available at http://erc.msh.org/quality&culture Accessed August 17, 2001.
- 14 Hedrick HL, ed. Cultural Competence Compendium. Chicago, IL: American Medical Association, 1999.
- 15 Lum CK, Korenman SG. Cultural sensitivity training in U.S. medical schools. Acad Med 1994; 69: 239–241.
- 16 Flores G, Gee D, Kastner B. The teaching of cultural issues in U.S. and Canadian Medical Schools. Acad Med 2000; 75: 451–455.
- 17 Zweifler J, Gonzalez AM. Teaching residents to care for culturally diverse populations. Acad Med 1998; 73: 1056–1061.
- 18 Culhane-Pera KA, Like RC, Lebensohn-Chialvo P et al. Multicultural curricula in family practice residencies. Fam Med 2000; 32: 167–173.
- 19 Liaison Committee on Medical Education. Standard on cultural diversity. Available at http://www.lcme.org Accessed August 17, 2001.
- 20 Association of Medical Colleges. Teaching and Learning of Cultural Competence in Medical School. Contemporary Issues in Medical Education. Association of Medical Colleges, 1998 Available http://www.aamc.org/meded/edres/cime/vol1no5.pdf Accessed May 20, 2002.
- 21 American Council for Graduate Medical Education. Outcome project: General competencies. Available at http://www.acgme.org/index.htm Accessed August 17, 2001.
- 22 Like RC, Steiner RP, Rubel AJ. Recommended core curriculum guidelines on culturally sensitive and competent health care. Fam Med 1996; 28: 291–298.
- 23 American Academy of Pediatrics. Culturally effective pediatric care: Education and training issues. Pediatrics 1999; 103: 167–170.
- 24 American College of Obstetricians and Gynecologists Committee Opinion. Cultural competency in health care. Committee on Health Care for Underserved Women. Int J Gynaecol Obstet 1998; 62: 96–99.
- 25 Culhane-Pera KA, Reif C, Egli E et al. A curriculum for multicultural education in family medicine. Fam Med 1997; 29: 719–723.
- 26 Carillo JE, Green AR, Betancourt JR. Cross-cultural primary care: A patient-based approach. Ann Intern Med 1999; 130: 829–834.
- 27 Garza-Trevino ES, Ruis P, Venegas-Samuels K. A psychiatric curriculum directed to the care of Hispanic patients. Acad Psychiatry 1997; 21: 1–10.
- 28 Thompson JW. A curriculum for learning about American Indians and Alaskan Natives in psychiatry residency training. Acad Psych 1996; 20: 5–14.
- 29 Jackson JJ. Race, national origin, ethnicity, and aging. In: R Binstock, E Shanas, eds. Handbook of Aging and Social Sciences. New York, NY: Van Norstrand Reinhol, 1985, pp 264–268.
- 30 Chee YK, Choi EE, Enslein J et al. Core Curriculum in Ethnogeriatrics. 2nd Ed. Yeo G, ed. October 2000. Available at http://www.stanford.edu/group/ethnoger Accessed August 17, 2001.
- 31 Henderson N, McCabe M, Scott VJ, et al. Ethnogeriatrics. In: S Klein, ed. A National Agenda for Geriatric Education: White Papers. Washington, DC: Bureau of Health Professions, Health Resources and Services Administration, 1996, pp 81–102.
- 32 Kleinman A, Eisenberg L, Good B. Culture, illness and care: Clinical lessons from anthropologic and cross-cultural research. Ann Intern Med 1978; 88: 251–258.
- 33 Berlin EA, Fowkes WC. A teaching framework for cross-cultural health care. West J Med 1982; 139: 934–938.
- 34 Stuart MR, Lieberman JA III. The Fifteen-Minute Hour: Applied Psychotherapy for the Primary Care Physician, 2nd Ed. New York, NY: Praegers, 1993.
- 35
Betancourt JR,
Carrillo JE,
Green AR.
Hypertension in multicultural and minority populations: linking communication to compliance.
Curr Hypertens Rep
1999; 6: 482–488.
10.1007/BF03215777 Google Scholar
- 36 Levin SJ, Like RC, Gottlieb JE. ETHNIC: A framework for culturally competent clinical practice. In Appendix: Useful clinical interviewing mnemonics. Patient Care 2000; 34: 188–189.
- 37 Foster DF, Phillips RS, Hamel MB et al. Alternative medicine use in older Americans. J Am Geriatr Soc 2000; 48: 1560–1565.
- 38 Eisenberg DM, Davis RB, Ettner SL et al. Trends in alternative medicine in the United States, 1990–1997. JAMA 1998; 280: 1569–1575.
- 39 Levin JS, Larson DB, Puchalski CM. Religion and spirituality in medicine: Research and education. JAMA 1997; 278: 792–793.
- 40 Task Force Report on Spirituality. Cultural Issues and End of Life Care. American Association of Medical Colleges Medical Objectives Report III: Contemporary Issues in Medicine: Communication in Medicine. October 1999. Available http://www.aamc.org/meded/msop/msop3.pdf Accessed May 20, 2002.
- 41 Welch M, Feldman MD. Cross-cultural communication. In: MD Feldman, JF Christensen, eds. Behavioral Medicine in Primary Care: A Practical Guide. 1st Ed. New York, NY: McGraw-Hill, 1997, pp 97–108.
- 42 Hopp FP, Duffy SA. Racial variations in end-of-life care. J Am Geriatr Soc 2000; 48: 658–663.
- 43 Irish DP, Lundaquist KF, Vivian J eds. Ethnic Variations in Dying, Death, and Grief: Diversity in Universality. Washington, DC: Taylor and Francis, 1993.
- 44 Blackhall LJ, Murphy S, Frank G et al. Ethnicity and attitudes towards patient autonomy. JAMA 1995; 274: 820–825.
- 45 Davis A. Ethics and ethnicity: End-of-life decisions in four ethnic groups of cancer patients. Med Law 1996; 15: 429–432.
- 46 Braun KL, Pietschi JH, Blanchette PL, eds. Cultural Issues in End-of-Life Decision Making. Thousand Oaks, CA: Sage, 2000.
- 47 Innovations in End-of-Life Care. Available at http://www.edc.org/lastacts/ Accessed August 17, 2001.
- 48 Kagawa-Singer M, Blackhall LJ. Negotiating cross-cultural issues at the end of life: “You got to go where he lives.” JAMA 2001; 286: 2993–3001.
- 49 Betancourt JR, Like RC. Editorial, a new framework of care. Patient Care 2000; 34: 10–12.
- 50 Bureau of Primary Health Care, Health Resources and Services Administration, Department of Health and Human Services. Cultural Competence: a Journey. Available at http://www.bphc.hrsa.gov:80/culturalcompetence/default.htm Accessed August 17, 2001.
- 51 Tervalon M, Murray-Garcia J. Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. J Health Care Poor Underserved 1998; 9: 117–125.