Comment le facteur culturel est-il considéré en psycho-oncologie ?

Abstract

Psychosocial cancer care must integrate the patient’s cultural issues and social and family background. Paradoxically, these aspects are still undeveloped for economic and cultural reasons, which explains the paucity of transcultural research in psycho-oncology.The challenge is to find out how best to transpose, to populations from different cultures, the various issues that have come to light in daily clinical psycho-oncology or been revealed by research projects in psycho-social sciences sponsored by organisms such as the INCa or Canceropôles (cancer research centres). It also involves thinking about specificity of screening and management when transcultural issues arise. Cultural factors impact on patients’ perception, comprehension and experience of their disease and its treatment, on the medical professionals involved and, in fine, on the doctor / patient dyad.These cultural issues influence the various psychooncological factors and the way in which psycho-oncologists generally approach them: communication and disclosure of bad news, the doctor-patient relationship, physical and psychological experience of pain, body investment, beliefs and meanings invested in cancer, coping with the disease, role of the family, access to psychosocial care, satisfaction with treatment, end of life.Thus it is necessary to promote transversal and trans-cultural research in the field of psychosocial oncology. Such research has been started, under the aegis of the International Psycho-oncology Society (IPOS), with respect to specific thematics, such as how to assess and care for emotional distress in cancer patients.Transcultural research into psychooncology must respect the ethical principles of autonomy and nonmaleficence when so-called informed consent is requested. This ethic is based on distinguishing between different socioeconomic, socio-linguistic, institutional and socio-cultural dimensions, without forgetting the methodological principles involved in this type of research.Daily clinical work in this transcultural field necessitates the acquisition by medical personnel of cultural skills enabling them to care adequately for all the patient’s needs. Such work requires an awareness of the acculturation concept, so that patients from different cultures who are confronted with the disease can be helped to deal with the stress engendered and improve their ability to adapt.The transcultural approach in psychooncology should be part of the psychosocial dimension and psychosocial cancer care. To this end, health professionals working in oncology need to be made more aware of the cultural dimension in cancer care and trained in how best to approach it. Research into transcultural psychosocial sciences must be developed and promoted, as to date it is a field of research that is seriously under-developed.