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PubMed2001

Negotiating cross-cultural issues at the end of life: "You got to go where he lives".

Culture fundamentally shapes how individuals make meaning out of illness, suffering, and dying. With increasing diversity in the United States, encounters between patients and physicians of different backgrounds are becoming more common. Thus the risk for cross-cultural misunderstandings surrounding care at the end of life is also increasing. Studies have shown cultural differences in attitudes toward truth telling, life-prolonging technology, and decision-making styles at the end of life. Using 2 case studies of patients, one of an African American couple in the southern United States and the other of a Chinese-American family in Hawaii, we outline some of the major issues involved in cross-cultural care and indicate how the patient, family, and clinician can navigate among differing cultural beliefs, values, and practices. Skilled use of cross-cultural understanding and communication techniques increases the likelihood that both the process and outcomes of care are satisfactory for all involved.

Black or African American↗
PubMed1999

Pleasure, pursuit of health or negotiation of identity? Personality correlates of food choice motives among young and middle-aged women.

The clustering of four food choice motives (health, weight concern, pleasure and ideological reasons) and the relationship between personality and the food choice motives were analysed among young and middle-aged women in two studies. The personality variables included personal strivings, magical beliefs about food, awareness and internalization of thinness pressures, appearance and weight dissatisfaction, depression, self-esteem and symptoms of eating disorders. Study 1 was done with 171 young and middle-aged women. In Study 2, with data provided by 118 senior high-school girls, one cluster of girls who did not regard any of the food choice motives as important was found, otherwise the food choice clusters were fairly similar in both studies. They were labelled as health fosterers, gourmets, ideological eaters, health dieters and distressed dieters. Only the second dieter group, distressed dieters, showed low psychological well-being and symptoms of disordered eating. The results also indicated that ideological food choice motives (i.e. expression of one's identity via food) were best predicted by vegetarianism, magical beliefs about food and health, and personal strivings for ecological welfare and for understanding self and the world.

Adolescent↗
PubMed1988

A case mix simulation decision support system model for negotiating hospital rates.

The institution of prospective payment systems by many health care insurers has drawn increased attention to case-based financial planning in hospitals. When hospital revenues are directly linked to patient diagnoses rather than to the types and quantities of services supplied to patients, managers must be aware of the financial implications of different case mixes and must be prepared to influence insurers' price structures. A case-based financial planning model is presented here for the purpose of assisting managerial decision making in the strategic areas of case mix planning and pricing. The computerized model characterizes hospitals as product manufacturers, the product being discharged patients. Diagnosis serves to differentiate the "products"; however, diagnoses are grouped by payor and similar treatment cost experiences to create a limited set of managerially meaningful case types. Diagnostic and treatment costs are also aggregated to facilitate the modeling of the hospital production process. The computerized model projects the number of patients of each case-type and total patient volume, based on estimated patient volume growth rates. The model also projects prices and contribution margins for each case-type, as well as total contribution to hospital overhead. Testing the model with a hypothetical example of a hospital strategic planning problem demonstrates the model's potential as a decision-making aid in case mix planning and case-type pricing. It also reveals several model shortcomings that require further developmental effort.

California↗