An American Indian Patient Experience

A Indian women in the Southwest United States experience higher ovarian cancer mortality rates compared to White women.1 High rates of overall cancer mortality and morbidity are attributed to delays and obstacles in seeking and receiving cancer screening or care.2,3 This commentary highlights several recommendations based on an American Indian ovarian cancer patient’s experience during treatment and end-of-life care with the goal of improving care for other American Indian cancer patients. On September 14, 2018, our mother, a 77-yearold American Indian woman, lost her battle with ovarian cancer. Our mother, like many other American Indians, had multiple comorbidities including anemia, congestive heart failure, asthma, type 2 diabetes, sleep apnea, obesity, and arthritis, among others. She was a widow, spoke English as a second language, had a 7th grade education, and had not been gainfully employed since 1963. Our mother’s comorbidities and socioeconomic status no doubt played key roles in her care and experiences. First, clinicians need to be prepared, forthcoming, and comfortable with imparting negative information; in doing so, they are adhering to the principle of respect for autonomy, one of the moral principles that apply to clinical practice.4 My mother and our family knew that the diagnosis of cancer was serious and were looking to the experts for guidance and information. No matter how negative the diagnosis and prognosis, clinicians need to impart what they know about a patient’s disease, its expected progression, and options for care to the patient and the family, including how to prepare for decisions that may need to be made. Furthermore, clinicians can better facilitate communication by identifying the preferences of the patients and family members on how to disclose bad news.5 So much confusion and frustration on our part could have been minimized if the clinicians had just been straightforward with us. Something as simple as informing our family that bowel obstruction6 is common in ovarian cancer patients would have been quite helpful. We also did not know the potential outcomes of malignant bowel obstruction and that percutaneous endoscopic gastrostomy (PEG) COMMENTARY