These study participants from the Detroit Orthodox Jewish community also mentioned issues of culturally appropriate, or kosher, communication and education, emphasizing modesty in language and behavior. The issue was raised within the group about whether, for instance, PAP smears fit within the confines of modesty.4

Also noted was a spiritual responsibility toward one’s health. However, while responsibility to take care of one’s health was expressed as a spiritual imperative, there was a concern that pursuing medical care may imply a lack of spiritual faith.4

General fear was mentioned as an obstacle to screening, which is not culturally unique, but members of the study community also explained that “cancer” is a term generally avoided out of fear, including a fear that mentioning the term could itself invite hazard.4

The role of one’s rabbi was noted as critical to the healthcare decision-making process for this community in terms of assistance with navigating many of the spiritual concerns that the participants raised.4

Genetics and Counseling

A 2016 study involving Orthodox Jewish thought leaders in Brooklyn, New York, also emphasized the role of the rabbi and other community leaders in consultation regarding healthcare decisions but hinted at shifting norms within the community concerning genetic testing and counseling.

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In this study based in Brooklyn, participants explained that fear of cancer was pervasive.5 Both study groups described a sense of inevitability toward a cancer diagnosis in addition to an inner debate around violating any plans of the divine vs the responsibility toward self-care.4,5

Genetic testing was described by participants in the Brooklyn group as being different in nature from cancer screenings; although cancer screenings provide actionable information for dealing with active disease, the concern was that genetic testing may veer toward interference with the plans of the divine. However, some participants expressed a view that current medical technologies are tools made available by the divine to enable self-care.5

Participants in each study also discussed a stigma around being identified as carrying a higher cancer risk due to family history or genetic testing.4,5 

The study participants in Brooklyn described a change in norms over time, with, for example, avoidance of the word “cancer” giving way to women more recently undergoing regular mammography and PAP smears. Concern over a possible stigma around cancer risk also appeared superseded by an openness to possibility around dealing with it.5

Conclusion

The authors of the Brooklyn-based study emphasized the value of rabbinic consultation to their respective communities and recommended that professionals in the oncology community provide resources to rabbis to assist with guidance of community members. They also urged patient care providers directly check with patients about their preferences, being careful not make assumptions based on cultural identity.5

Fleischmann emphasized the importance of healthcare providers initiating culturally competent conversations with their patients as soon as possible. “It’s important to have an open conversation about cultural needs from the outset to set the stage for a supportive relationship,” she explained.

Culturally competent care for Jewish patients is, like so much of health care, improved by clear and open communication. “Ask your patients about their culture — let them be the experts! Find out what’s important to them, and ask how you can best meet their needs,” Fleishmann concluded. “Cultural competency is a journey — don’t be afraid to ask questions, and turn to your resources for support!”

References

1. Brach C, Fraser I. Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model. Med Care Res Rev. 2000;57 Suppl 1:181-217.

2. Jewish women and BRCA gene mutations. Centers for Disease Control and Prevention (CDC) website. https://www.cdc.gov/cancer/breast/young_women/bringyourbrave/hereditary_breast_cancer/jewish_women_brca.htm. Updated November 5, 2018. Accessed December 17, 2018.

3. BRCA gene mutations. Centers for Disease Control and Prevention (CDC) website. https://www.cdc.gov/cancer/breast/young_women/bringyourbrave/hereditary_breast_cancer/brca_gene_mutations.htm. Updated November 5, 2018. Accessed December 17, 2018.

4. Tkatch R, Hudson J, Katz A, et al. Barriers to cancer screening among Orthodox Jewish women. J Community Health. 2014;39(6):1200-1208. 

5. Bressler T, Popp B. Orthodox Jewish thought leaders’ insights regarding BRCA mutations: a descriptive study. J Oncol Pract. 2017;13:e303-e309.