Strategies for Culturally Effective End-of-Life Care

Abstract

As a result of profound worldwide demographic change, physicians will increasingly care for patients from cultural backgrounds other than their own. Differences in beliefs, values, and traditional health care practices are of particular relevance at the end of life. Health care providers and patients and families may not have shared understandings of the meaning of illness or death and may not agree on the best strategies to plan for the end of life or to alleviate pain and suffering. Good end-of-life care may be complicated by disagreements between physicians and patients, difficult interactions, or decisions the physician does not understand. Challenges may result from cultural differences between the patient's background and traditional medical practice. Values so ingrained in physicians as to be unquestioned may be alien to patients from different backgrounds. Physicians need to be sensitive to cultural differences and to develop the skills necessary to work with patients from diverse backgrounds. Community and cultural ties provide a source of great comfort as patients and families prepare for death. This paper describes two cases that raise issues about cross-cultural end-of-life practice and suggests strategies for negotiating common problems. Physicians should assess the cultural background of each patient and inquire about values that may affect care at the end of life. They should become aware of the specific beliefs and practices of the populations they serve, always remembering to inquire whether an individual patient adheres to these cultural beliefs. Attention to cultural difference enables the physician to provide comprehensive and compassionate palliative care at the end of life.

Development, Feasibility, and Acceptability of the Family/Adolescent-Centered (FACE) Advance Care Planning Intervention for Adolescents with HIV

“…37 FACE demonstrated feasibility, enrolling the targeted sample size and yielding a high rate of satisfaction for African American families, who generally have been underrepresented in EOL research (NIH State of the Science Conference Statement on Improving End-of-Life Care, December [6][7][8]2004). The adaptation of the sessions to be culturally sensitive through a process of community review [38][39][40][41][42][43] was successful. African Americans historically have experienced discrimination by health care institutions 44 and may interpret discussion of do-not-resuscitate (DNR) orders as euthanasia or an attempt to deny beneficial care, 45 which may account for the low levels of hospice care or use of DNRs among the 41 children who died during Pediatric AIDS Clinical Trials.…”

A Family's Request for Complementary Medicine After Patient Brain Death

“…[9][10][11] In this case, does the family reject the brain death criterion on religious grounds? Does the request simply reflect temporary reluctance to accept bad news, and not principled rejection of the criterion?…”

Cancer patients, emergencies service and provision of palliative care

“…24,25 However, we see that the referral of patients to PC services has occurred repeatedly in the late stages of the disease, representing a major barrier to access in many parts of the world. 26,27 The finding that few cancer patients treated at the ER were in PC or HC promoted a discussion among professionals of the institution in order to create expansion strategies. This is because the evidence shows that the implementation of these instances of care improves symptom control and the quality of life of cancer patients, reducing the demand for emergency care.…”