How Culturally Competent Care Is Different for Jewish Women With Breast Cancer
Cultural and religious beliefs of Ashkenazi Jewish women may complicate counseling and education on breast cancer screening and genetic testing.
Culturally competent care is an approach to healthcare delivery that incorporates strategies for reducing cultural disparities in health care and can involve training, interpreter services, coordination with community leaders, and other techniques.1
Culturally competent care may be important to consider when dealing with populations that are more susceptible to certain medical conditions. One example of such a susceptibility is the relatively high prevalence of BRCA1 and BRCA2 mutations within the Ashkenazi Jewish population, which confers a greater risk of certain cancers, including breast cancer.2
According to the Centers for Disease Control and Prevention (CDC), 1 of every 40 Ashkenazi Jewish women carries a BRCA mutation, compared with a prevalence of 1 of every 500 women in the general population.2,3 The CDC also estimates that approximately 50% of women with a BRCA1 or BRCA2 mutation will develop breast cancer by age 70, compared with 7% of women overall in the United States.3
Although culturally competent care takes a patient's cultural characteristics into account, each person is an individual who may deviate from cultural norms and whose individual values are paramount.
“Oncology nurses and nurse navigators need to know that there are many different ways that individuals and families relate to being Jewish — it's not a one-size-fits-all! There are different ways to help Jewish patients feel most comfortable and there are resources developed to help oncology nurses and oncology nurse navigators meet those needs,” Adina Fleischmann, director of support programs at Sharsheret, a national nonprofit organization supporting young Jewish women with breast cancer, told Oncology Nurse Advisor.
Resources supporting culturally competent care are available for clinicians, and the continuum of care can additionally include rabbis and other religious leaders of Judaism. “Nurses and nurse navigators can access culturally competency trainings and culturally sensitive resources through Sharsheret. Additionally, local hospital chaplains and clergy are often trained in these resources,” explained Fleischmann.
People of Ashkenazi Jewish ancestry may identify as secular or may practice one of many forms of Judaism. Orthodox Jews generally show the greatest adherence to religious law, and this may shape concerns they could have as patients.4
Understanding Unique Beliefs
In a 2014 study comprising members of the Orthodox Jewish community in Detroit, Michigan, researchers identified a few elements of religious observance that these members described influencing their thoughts on healthcare.4
The notion of hidden miracles, or divine intervention operating in unseen ways, caused concern among some participants that taking actions such as cancer screenings may preclude the possibility of hidden intervention, because a disease would then become exposed to awareness.4
Study participants also expressed a sense of inevitability — a belief that screenings or preventive measures do little to change the course of one's fate. Some concerns related to high costs coupled with insufficient insurance, as well as prioritization; regular schedule demands, including preparing for weekly Sabbath often taking precedence over a person's own medical screenings.4