Clinical social workers help navigate complex cultural issues

Social workers can help navigate cultural issues
Clinical social workers can address the unique psycho-social needs of Asian families, who often take on an enormous amount of caregiving.
Language and cultural differences can be serious obstacles for cancer patients and their families seeking medical and emotional support. A lack of clear communication creates an isolating and confusing environment that can greatly hinder recovery — a problem that’s particularly prevalent in multicultural Southern California.
Wires can be crossed. Cultural discrepancies can lead to lack of meaningful understanding. City of Hope’s Department of Supportive Care Medicine has taken the lead on these issues, assigning bilingual clinical social workers to coordinate care and offer counseling to a diverse patient population, said Jenny Rodriguez, social worker for the Spanish-language Couples Coping With Cancer Together program.     
“The primary goal of our program is to reduce barriers to access psycho-social services and improve treatment outcomes for Latino couples facing a breast cancer diagnosis,” she said. “Couples Coping With Cancer Together primarily aims to service monolingual couples who may experience barriers to accessing care — language, resources, culture and other factors.”
It’s a vital element of treatment for City of Hope’s Hispanic and Latino patients, which comprise 22% of the medical center’s population, she added. Although language can be a considerable barrier to treatment, understanding social and cultural issues can be equally important.
“What is known about the Latino patient population is that they are often financially vulnerable, challenged with background social issues, and face various language and cultural barriers that prevent them from fully understanding the details of their medical care,” Rodriguez said.  “Latino cancer survivors also report limited emotional support from their partners.”
Creating a safe space for open dialogue and teaching psycho-social coping skills are essential elements of the program. And since the Latino culture puts an emphasis on family, “ensuring the strength of the family and social bond is critical to optimal health outcomes,” she added.  

Bridging language and culture

Inclusion of the extended family in identifying psycho-social needs is crucial in counseling Asian patients, said Jenny Lu, bilingual clinical social worker for the breast cancer team. Reading between the lines is important, since so much is unsaid; you need to look closely and identify who the leader of the family is, who the key players are, she said.
“It’s like the iceberg metaphor,” Lu said. “Above water is all you see, but there’s so much more going on unseen below. It’s so important that we see the whole patient, and are sensitive to their family and culture. Clinical social workers are the front line of mental health and risk assessment at City of Hope.”
For Lu, a native of Hong Kong, that means being especially sensitive to the cultural perception of cancer as something shameful, as well as the exceptional burdens taken on by Asian families. Psycho-social support can extend well beyond the needs of the patient and spouse, she said.
“A cancer diagnosis can be seen as a death sentence, a sign of genetic family-line weakness,” Lu said. “It can be seen as punishment for their sins, or sins of a past life. Asian families also take on tremendous responsibility for caregiving, so it’s important to address the needs of the entire extended family. Asian culture is rooted in Confucianism. It’s all about family, community and country.”
City of Hope offers a number of classes to help support Asian patients, teaching coping strategies, pain management, proper nutrition and more. Culturally respectful spiritual and wellness needs are addressed with courses in mindfulness and meditation, yoga and tai chi.
“Asian patients and family members feel comfortable interacting with teachers and asking questions in our class settings,” Lu said. “I feel that City of Hope is one of the leading medical centers in cultural support. And my patients tell me it’s a very special place.”

Community outreach

City of Hope’s cultural outreach goes well beyond the walls of the medical facility, into the communities it serves and beyond. Couples Coping With Cancer Together, for instance, has been presented to Spanish support groups at Cancer Community Support in Pasadena, California, and elsewhere, Rodriguez said.
Lu has worked with the American Cancer Society’s Chinese Cancer Support Group and has given presentations on Asian culture for national conferences, including the Association of Oncology Social Work. She also spoke at the conference “When East Meets West,” a training ground for multidisciplinary providers in the San Gabriel Valley.
It’s all part of City of Hope’s attempt to educate culturally diverse populations as well as share knowledge and strategies with other cancer facilities, Rodriguez said.
“Our vision for the future is to train other cancer centers, especially community-based clinics and mental health clinicians,” she added. “Our goal is to reduce barriers to accessing psycho-social services. We want to provide the skills necessary for couples to deepen their commitment and connection to each other so they will be able to live the relationship they have always wanted.”