Continuing Education—September 2013
Cultural Diversity and EOL Care
(from Hospice Foundation of America, www.hospicefoundation.org)
Addressing Cultural Diversity in Hospice: The Volunteers Perspective
1. For many of us it is a human instinct to hope for comfort, peace, and dignity, and to be surrounded by loved ones at the end of life. Yet, there are differences in how people cope with dying and death; many of these differences reflect deeper values and priorities, often influenced by culture and circumstance.
2. Culture refers to the beliefs, customs, practices, and social behavior of a particular nation or people and is often referred to as a “way of life.” We learn about, and define culture from, our families of origin as well as the groups or communities that we choose to be a part of.
3. Many people claim multiple identities, which may include race, religion, ethnicity, gender and social class. These identities may or may not always have the same level of equal personal importance to people as they try to manage end-of-life care for themselves or a loved one.
4. A 2009 profile of hospice patients showed that 80 percent were white or Caucasian. Close to one in every three persons in the U.S. belongs to a racial or ethnic minority group, yet hospice is underutilized by minority groups in the U.S. The reasons for lower hospice usage by minority groups are complex.
5. People of color are more likely than whites to lack health insurance, to receive lower-quality care and to suffer from worse health outcomes, according to a report from Families USA. The causes of these disparities are broad and complex, ranging from societal issues like poverty and racism, to health system factors such as access to health care facilities and services—including hospice care.
6. Hospice professionals and volunteers can help overcome disparities to create trust, increase access to hospice care and educate minority groups about end of life options. When hospice providers and volunteers communicate clearly and honestly with prospective patients, families and health professionals, while being sensitive to potential cultural beliefs and experiences, these efforts can help ease someone’s comfort with, and acceptance of, hospice.
7. Hospice organizations can promote awareness and sensitivity by providing cultural competence training to staff and volunteers. The Office of Minority Health defines cultural competency as “the way patients and health professionals can come together and talk about health concerns without cultural differences hindering the conversation, but enhancing it.”
8. Effective hospice professionals and volunteers are sensitive to the fact that their own values and beliefs are not always the same as their patients’. They are aware of their own biases and monitor the potential effects of these biases on their hospice practice.
9. Language and cultural barriers should be addressed in a hospice organization’s written training and marketing materials. It is important that materials are translated and interpreted in a way that is appropriate to a select language and culture.
10. Hospices are founded in the philosophy of comprehensive, patient-centered care, but the reality of achieving cultural competency is an ongoing challenge. General realities about particular cultural beliefs must always be balanced with the recognition of the individual’s needs and concerns.
The HFA has published a comprehensive text on this subject, Diversity and End-Of-Life Care: Part of the Living with Grief Series, which we have in the Volunteer Services Library. Section I deals with the general topic of cultural diversity. Section II addresses Ethnicity and Race as Sources of Diversity, specifically African Americans, African and Caribbean migrants, American Indians, and Hispanics. Section III covers Diverse Spiritualities, including Jews, Muslims, Buddhists and Christian Evangelicals. And Section IV covers persons with intellectual disabilities or deafness, patients with PTSD, and patients in the LGBT communities.
If you find yourself working with a patient and family whose culture is different than your own in ways that make you unsure of yourself, please contact Carolyn for guidance. And remember that an approach that almost always works is to ask respectful questions and listen attentively for the answers. If you are familiar with one of our many diverse patient populations and would like to share your knowledge with your fellow volunteers please let Carolyn know.
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