Cultural Diversity in Palliative Care

Cultural diversity in the medical field in regards to palliative care is, at times, greatly hindered because of religious beliefs, language barriers, and the hierarchies of diverse cultures, and these have the propensity to affect the continuity of care for the patients. People from different cultures have their own perspectives on health and disease. Some cultures believe in using traditional medicine, and some believe in the healing power of praying and herbal healing.

People are often affected by their own cultural beliefs when it comes to diseases, and how they can find the right cure or die with the dignity they have through the dictation of their culture. Sometimes, religion and cultural beliefs get in the way of receiving the medical help they need. Every person has different aspects that constitute their identities, according to how they see themselves. Religious beliefs for example can hinder the nursing care of patients. There are many different religious beliefs in as many different religions.

The religious belief most common in the United States, of course, is the Jehovah Witness who refuses transfusions. This religion has a strong belief in preserving the soul before the body. In recent years, the notion of cultural competence has come to encompass both interpersonal and organizational interventions and strategies that seek to facilitate achievement of clinical and public health goals when those differences come into play. “In 1991, the United States legislature implemented the Patient Self-Determination Act otherwise known by the acronym PSDA, to serve as a manner in which end-of-life care and considerations were made.

It incorporates not only the Advanced Directive of life-sustaining technology, but also shifts the clarification and protection of an individual’s health care decisions to the patient rather than from the doctor” (Giger, Davidhizar, Fordham pg 32 2006). The assessment factors that are added to the PSDA include communication, space, time, environmental control, social organization and biological variations. Within these variations, main attributes include patient autonomy that states any patient has the inherent right to make any medical decisions and should be an active participant in their own care.

Also, information will be provided openly, and that the patient should have complete control over their own life and dying process. Although this is true in most cases, how the patient and the family view this truth can vary according to their cultural background. With that being said , to just assume complete cultural diversity without regards to each individual’s views within a said cultural group can be detrimental to not only the that individual, but also the healthcare team as well.

Historically, migrants are underrepresented in palliative care services (K. Lum pg. 22 2003). While the reason for this probably lies with the lack of appropriate referrals and issues around health literacy in the migrant group, palliative care services can work towards being better equipped to cater to people from culturally and linguistically diverse backgrounds. Apart from meeting any legal obligations, focusing on the needs of the patient results in better outcomes and has the potential to achieve better efficiency in our health service system.

Implementing diversity-responsive policies in palliative care services ensures that a service can meet the needs of non-English speaking patients, while still promoting their safety and meeting policy and legislative requirements. “Diversity-responsive palliative care may require initial resource increases in some areas (such as policy development, interpreting, translating, added clinician time and some systemic changes), yet it will save resources in the longer term. For example, the appropriate use of interpreters can result in more effective health assessments and outcomes when a clinician and patient are able to communicate effectively.

Minimizing miscommunication results in improved assessment and improved care for the patient and the family” (Addington-Hall pg. 34 1995). In Palliative Care, cultural incongruence between patient and provider can be amplified and significantly impact on care. “Migrants may not understand what palliative care is about and may misunderstand interventions. It can also have an influence of the ability of the health care provider to interact appropriately with a patient, due to stereotyping of cultural groups, fear of making mistakes and lack of skills in cross-cultural communication” (Addington-Hall pg. 4 1995). All of these experiences and expectations of discrimination may also be an issue for some patients and their families. This can be particularly difficult in the context of palliative care as it may be perceived as hastening death. It can also have an impact on whether the patient and family are prepared to engage in advanced care planning, requiring that the service provider build the patients trust before any progress can be made.

The Federally funded Translating and Interpreting Services is provided free of charge to Medicare funded patients while they are in the hospital, but state funding for this service can be quite expensive. All cultural groups have certain structural requirements for them to feel comfortable. “Community palliative services therefore need to consider issues about appropriate times to visit, knowledge about dietary issues (including fasting times and medication components etc. as well as funeral arrangements and dealing with the body shortly after death, however, as the family is in control of the patient’s environment, these issues may not impact as significantly on patient care as they might in inpatient services.

Cultural requirements different from the mainstream can sometimes be difficult to cater for, in particular in inpatient services and may include the need to access prayer spaces, running water for washing, accommodating large groups of visitors and dietary requirements including catering for food brought in by the patients family” (K. Lum pg. 22 2003). For this reason, it is imperative that the healthcare team understand and respect the cultural beliefs regarding the patient’s pain control. “Some cultures believe that it is the patients life-affirming will to fight back against the dying process, while other cultures see it as a punishment, an evil spirit, a cleanser or a body builder” (Giger, Davidhizar, Fordham pg. 32 2006).

In cancer patients though, it is sometimes necessary to have medicinal sedation to help the patient with pain. Certain criteria for patients and their families are based upon certain key indications. “The healthcare team needs to address the criteria for the sedation, the decision-making process and informed consent, discontinuation of interventions that are not focused on comfort and continual monitoring of both the patient and family members” (Babarro, Barrientos, Bruera, Cerdeira, Vigil pg. 26 2010). Working effectively in palliative care to address the social and cultural diversity of patients requires the healthcare field to move away from the pre-occupation with cultural stigma and just see the patients for who they are. There needs to be a critical assessment done of our health care system and a reflective practice by all who call themselves caregivers, practioners or support staff.

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