Transculturalization initiative addresses diverse needs in Latin American patient care

Issue: June 2016

ORLANDO, Fla. — New recommendations spearheaded by the American Association of Endocrinologists and the American College of Endocrinology will help bridge the cultural gap in the care of diabetes, obesity, thyroid and bone health in Latin American countries, addressing the diverse regional factors that can impact patient care, according to a speaker at the AACE Annual Scientific and Clinical Congress.

Jeffrey I. Mechanick, FACN, FACP, FACE, ECNU , chair of the AACE/ACE Transcultural Endocrinology Task Force and ACE president-elect, said the transculturalization process adapts management guidelines into clinical practice in a culturally sensitive manner, factoring in diverse socioeconomic, behavioral, environmental, ethnic and even political factors that can vary by region.

Jeffrey I. Mechanick

The recommendations follow an AACE/ACE workshop conducted in February 2015 in San Jose, Costa Rica, which was organized with the goal of optimizing clinical practice algorithm development for Latin America in diabetes (focusing on glycemic control), obesity (focusing on weight loss), thyroid (focusing on thyroid nodule diagnostics) and bone (focusing on postmenopausal osteoporosis). Mechanick and colleagues performed analyses of transcultural factors by disease category and developed recommendations organized according to algorithm “nodes.” The recommendations address screening/aggressive case findings, stratification, diagnostics, intervention, metrics and follow-up intervention by country.

The resulting document has been translated into Spanish and is available on the AACE website. The recommendations were also published online in Endocrine Practice.

“The goal was not to produce a final product algorithm for use in each country,” Mechanick said. “Rather, the goal was to provide education, instruction and very detailed guidance for how local thought leaders could create their own local templates or local algorithms for those problems, if they should so desire.”

Referencing the new AACE clinical practice guideline for obesity management as an example, Mechanick said such a guideline will not serve clinicians and patients well if it cannot be implemented for everyone. Different cultures and ethnicities, he said, have different obesity phenotypes.

“Even if you gaze within the borders of our country, you see that almost the majority of Americans represent some minority category,” Mechanick said. “We’re dealing with many ethnicities and cultures in an average endocrine practice in this country. How on Earth are you going to be able to implement these comprehensive obesity guidelines when we’re dealing with different cultures and different attitudes toward doctors and medicines, toward food and toward activity? That is the challenge.”

Building on the recommendations, the committee plans to create a Center for Transcultural Endocrinology (ACTE) within ACE this year, according to R. Mack Harrell, MD, FACP, FACE, ECNU, past president of AACE and a member of the Transcultural Endocrinology Task Force.

R. Mack Harrell

Harrell said the committee has faced “a bit of a bias” in the first year of planning activities, in part because there has been a misunderstanding by some that transculturalization meant traveling to other countries to tailor U.S. guidelines for specific cultural needs.

“What we have tried to impart ... is that this is a limited view of what transculturalization is,” Harrell said. “Transculturalization is about making the AACE/ACE guidelines accessible to all ethnicities within our country as well. In recognition of that understanding problem, we are in the process of looking at putting together a consensus conference in an inner city area in the U.S., to put together guidelines for managing the transcultural needs of those specific inner cities.”

Harrell said ACTE plans to convene such a conference within the next year.

“The weight-loss needs of a laid-off auto worker in Detroit, Michigan, are going to be completely different from a retired Washington bureaucrat in Boca Raton, Florida,” Harrell said. “We need to reconcile these needs and be able to customize our guidelines to be able to fit all walks of life, and that is what ACTE is about.”

The goal of ACTE will be to facilitate communication between groups, Harrell said, and not to rewrite new guidelines for specific cultural groups. Instead, he said, the individual constituencies can develop their own modification to the guidelines.

“It’s about allowing people to make their own modifications, based on their own needs,” Harrell said. “We start the process, it’s a group encounter ... so when they [clinicians] encounter an individual patient, they have the tool kit and the skills to culturally adapt their recommendations.” – by Regina Schaffer

References:

Mechanick JI. Transculturalization Recommendations for Developing Latin American Clinical Practice Algorithms in Endocrinology. Presented at: AACE Annual Scientific and Clinical Congress; May 25-29, 2016; Orlando, Fla.

Mechanick JI, et al. Endocr Pract. 2016;doi:10.4158/EP161229.GL.

Disclosure: Mechanick reports receiving honorarium from Abbot Nutrition. Harrell reports no relevant financial disclosures.