Patient-centered care and cultural practices: process and criteria for evaluating adaptations of norms and standards in health care institutions.

It is widely recognized that health care providers and health care organizations need to take into account the cultural frameworks of patients.Such an orientation is consistent with patient-centered care that focuses on the particularity of individual patients (Stewart, 2001). In a patient-centered approach clinicians individualize the care they provide to each patient, and seek to develop and promote partnerships with patients. Eliciting and engaging a patient's cultural values and perspectives is a key component of patient-centered care. An important body of scholarship has developed around the question of how attending to the needs of culturally diverse patient populations should affect the provision of clinical care and other health services (Betan court, 2004). This discussion has led to many practical changes in how health care providers are trained. Today, educational programs in faculties of medicine, schools of nursing and schools of allied health incorporate cultural competence training in their curricula.Despite the increased focus in education and clinical practice on providing patient-centered and culturally sensitive care, challenging situations can arise when patients wish to perform practices that do not fit within institutional or clinical norms. In many such situations, health care providers and hospital administrators adapt institutional or clinical norms and structures. In other cases it may be difficult to decide whether particular adaptations should be made or not. Such scenarios may be sources of important concern and stress for patients, families and health care providers. The assessment of a given situation is rendered more complex when the adaptation being considered has the potential to infringe on the rights of others (such as other patients,visitors to the hospital, or health care providers). In this paper, I propose a328 HEC Forum (2009) 21(4): 327- 339 process, including four evaluative criteria, for assessing such scenarios. This discussion is also relevant for considering practices that require adaptation of institutional or clinical norms, but which are not based in a specific cultural or religious framework. Given a commitment to respect autonomy,administrators and clinicians should also carefully consider requests for adaptation which patients associate with their own core beliefs and deeply held commitments.