Instructional Strategies

In addition to lecture and reading assignments, the following case can be used for discussion or written assignments.

Case Study 1

A 65 year old Chinese woman who immigrated to the U.S. in 1995 to live with her eldest son and his American wife is brought in for a one week history of malaise, nausea and vomiting, and sudden jaundice. She is admitted to the hospital where diagnostic studies reveal an obstructive mass in the liver. Biopsy reveals hepatocellular carcinoma.

Serologies show chronic active hepatitis B status. As the attending physician, you ask the son to help translate and break the news to his mother that she has cancer. He is very concerned about his mother’s diagnosis and prognosis, but asks you not to tell his mother that she has cancer. You feel that it is important that the patient know her diagnosis, but he is firm that he does not wish his mother to know this. Despite his wife’s recommending that she be told, he refuses. You try to discuss end of life issues such as hospice care and “do-not-resuscitate” (DNR) orders, but when you bring up these subjects, he tries to discuss other issues such as when can she go home.

	Discussion Topics: Cultural issues that may be involved in this case—
	1. Protection of elderly and filial piety 2. Superstition: discussing an illness or death/dying is bad luck. By talking about something bad, it may come true. 3. Increased incidence of liver cancer related to Hepatitis B in Chinese immigrants. 4. Access to interpreter services. 5. Access to clear end of life care options.

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