Diversity and End-of-Life Care Segment Summaries

Segment 1 - Understanding Diversity

  1. In an increasingly diverse society, hospices, hospitals, and other organizations offering care at the end of life need to be attentive to that diversity as it influences not only access to end-of-life care but also the variations and quality of that care.
  2. Diversity should be defined broadly.  Sources of diversity can include race and ethnicity, religion and spirituality, socio-economic status, geographic identification, gender, age, sexual orientation, and other factors, such as physical or mental disability.  While it is important to understand the ways these sources of diversity influence patients’ needs, access to and perceptions of care, diversity is also essential to patients’ self-identification and understanding of needs.  Individuals should not be identified by a single attribute; people have multiple cultural identities and individual differences, yet all share core human values and needs.
  3. Culturally proficient practitioners appreciate the challenges inherent in learning about diversity and possess the courage to continue to develop and to learn as they practice.  Such culturally proficient practitioners listen; recognize their limitations, biases and needs; are comfortable with and aware of their own cultural identities; are open to change; and collaborate with peers and other work partners. Such practitioners embrace a more comprehensive understanding of diversity as a tool to provide quality end-of-life care.
  4. Diversity is not only an attribute of the populations served by end-of-life organizations. End-of-life organizations, and all health care and social service organizations, should nurture a diverse staff and support staff as they continue to develop as culturally proficient practitioners.

Segment 2 - Diversity at the Time of Death

  1. Culturally proficient care at the end of life begins with a careful assessment of the patient and family and their perspectives on the diagnosis, illness, prognosis, and medical and cultural needs.  The hospice model of interdisciplinary team assessment that considers medical needs and also psychological, social, and spiritual needs is a model for effective assessment.  In working with culturally diverse populations, culturally proficient practitioners should incorporate traditional practices, complementary therapies and traditional healers within the best medical, nursing, spiritual, and psycho-social end-of-life care.
  2. Culturally proficient care begins long before the end of life.  Hospices, hospitals, and other end-of-life organizations need to educate communities at the grassroots level by speaking to faith communities, local organizations, and other culturally appropriate groups.  This may entail that end-of-life organizations examine themselves first by completing their own self-studies and environmental scans.  Are materials available in the language of local groups?  How does the organizational environment reflect diversity?  How diverse is the organization’s management and staff at every level?  How diverse is the volunteer base? If changes need to be made, where do organizations begin?
  3. Culturally proficient organizations use diversity as a strength.  Diverse staff can have a role as educational resources to one another.  Management needs to model open communication, care with language, and mutual respect, and sensitively recognize and confront tensions as they arise.
  4. Circumstances at the time of death may offer particular opportunities to provide culturally sensitive care. Hospice professionals can benefit from collaboration with spiritual communities and funeral homes. Hospice providers can also serve as a resource to education for other health care professionals and others about culturally appropriate grief responses. 

Segment 3 - Diversity in Bereavement Care

  1. Culture influences reaction at the moment of death as well as the experiences and expressions of grief, the rituals that surround the loss, and the ways of showing support and sympathy.  There may be generational and other differences within broadly defined cultural groups.  Counselors should sensitively assess grief reactions within a cultural context.
  2. While short-term interventions may be limited to condolences and invitations for further contact, longer-term strategies should offer multiple approaches that are culturally appropriate, including psycho-education, rituals, and other forms of grief support such as self-help groups and counseling.
  3. Services should be developed based on careful assessment of needs and marketed sensitively based on community norms.  Cultural liaisons can be very helpful in designing and publicizing culturally proficient grief support services and in increasing diversity in the populations served.  Cultural liaisons can assist in strengthening community collaboration and mutual learning.
Providers