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End of Life Care and Ethnicity

Our Australian community is culturally diverse with approximately half of the population being migrants whilst the other half is predominately Anglo-Celtic origin.  Despite Australia’s cultural diversity, the ethnic minority still continue to have difficulty in access the health care systems, let alone culturally appropriate care which include palliative and end of life care.  This disparity of access to health care for anyone requiring such care ignores our basic human right to live and die in comfort.

Within such diversity, there will be differing beliefs and cultural specific ideology towards death and dying.  This can be challenging prospect for some health professionals.

What are the barriers to accessing health care?

Health care professionals can sometimes be challenged when sourcing appropriate end of life care for all population groups whilst being culturally aware, remaining sensitive to their cultural needs and ensuring cultural competence.

There can be numerous factors that influence a person’s cultural values and beliefs that are learnt throughout their life.  Cultural awareness is the ability to acknowledge these differences.  In the health care context, cultural sensitivity means a health care professional understanding on how one’s culture may shape their views.  The health care professional will also need to respect differences even if they are not aligned with their own.  This may require the health care professional to explain the medical processes and diagnosis a little clearer, often some translation or explanation to lay people in a non-medical terminology method to ensure their understanding.

Improving access to end of life care

Ensuring that people have equal outcomes at the end of life requires an awareness and true commitment to deliver a culturally appropriate palliative care plan. An appreciation of whether or not there may be social, political or historical issues (like ware or famine) that could impact on the patient and health care professional’s relationship should be sought. Delivering culturally appropriate care is built on a foundation of trust, respect of the patient’s culture, age, gender and their beliefs – both political and religious.

Improving palliative care for all people requires the cultural competence of all parties involved in the delivery of the patient’s care; from the individual patient to the health care professionals and even the health care system’s capacity to foster cultural competent palliative care.

Cultural factors can shape a patient’s preferences around their decision making and their reaction to receiving bad news and end of life care.  In Australia, our emphasis on patient autonomy, informed consent and telling the absolute truth is often not always well received with all beliefs and values of some cultural groups.  They may place a greater value on family involvement in the decision process.

In some cultures, discussing death is actively discouraged and is considered to be disrespectful and inviting death.   It may also add to depression and anxiety for the patient.

Communication with health care professional

Some people want to know everything about their medical condition and others do not.  It is up to the health care professional to assess or ask how much the family would like to know.

Do they prefer to make medical decisions for the family member or leave that to be directed by health care professionals?  Would you like to be in the room when the doctor or health care professionals speak with the patient?  Would there be any cultural beliefs, practices or preferences that might affect the patient that should be communicated early in the treatment plan.  Would there be any specific practices that are really important to the patient at the time of death or afterwards that should be known? 

Death is as inevitable as taxes for everyone but everyone’s experience of death is unique.  Providing care for a person as they commence their final stages of life is usually a stressful and sad time for families and loved ones.  Different groups will have different attitudes towards medical assistance, resuscitation and pain management.  In some cultures, pain is viewed as punishment whilst for others it is viewed as the body fighting to overcome the disease.

In Australia it is not uncommon practice for specialist palliative care to be offered as in-home service with health care professionals including Your Home Care being available to assist.  For some cultural groups they may invite religious or spiritual practitioners to attend the dying patient. There may be some culturally specific rituals to be observed after death.  When choosing to die at home, there can be some restrictions that will require negotiation and planning compared to dying in a hospital.

Regardless of the ethnicity of the family concerned, rituals around the time of death are important for the person who died, for those close to them and for their community.  Such rituals allow confirmation of the death and provide a clear separation between the living and the dead, then allowing an opportunity to begin the task of assigning a new identity to the deceased which is an important part of successful bereavement for those left behind.

Despite different beliefs, universal care needs valued at the end of life include the provision of comfort, appropriate communication between all parties including the patient, respect for spiritual beliefs and the opportunity for the dying patient to say farewell to their loved ones.

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