Cultural and Religious Issues - PowerPoint Presentation

Slide1

Cultural and Religious Issues Impacting End-of-Life Care

Sheri Mila Gerson, LICSW, ACHP-SWAnne Roberts, MSSW, LSWAIC Mark Snelling, D. Min

Washington State Hospice and Palliative Care Organization

Fall Conference, Chelan, Washington

October 10, 2017

Objectives

identify at least two ways cultural backgrounds or religious beliefs impact current

hospice or palliative care practice

describe

at least three cultural and religious practices at end of life which may be “outside usual experience” identify several measures to implement in work setting to facilitate a more open and accepting response to others’ cultural or religious practices.

What impact does culture play on end-of-life care

?

How

can Hospice and Palliative Care staff respectfully support the diverse, multi-cultural patient populations being served?

What is culture?

Ethnic Heritage

Spirituality

Socio-economic status

Generational influences

Community of residence

Beliefs

Historical events

What makes up culture?

Gender

Age

Race

Migration

Colonization

Personal Narrative

PROFESSIONAL

Influenced by

Worldview

Palliative Care Challenges:

The culture of the individual requesting hospice/palliative careEmotional expression/experience of grief by patient/familyRequests by family regarding

disclosure to

patient

Conflicted or diverse perspectives of family members Use of interpreters After death plans and ritualsOrganizational policy regarding end of life options or treatmentsHome and community

resources

Patient Self Determination Act: 1. Patient autonomy

people have the inherent right to make treatment decisions and should be active participants in their own care.2. Informed decision making

people

have access

to all the information relevant to the particular decision.3. Truth tellinginformation provided will be provided openly by health professionals4. Control over the dying processpeople should and can have control over their own life and death.(Giger et al., 2006)

(Giger et al., 2006; Lubimir & Wen, 2011;

Zager & Yancy 2011)Truth-telling

Autonomy

Informed-decision making

Values vary among people:

In some

cultures or traditions, to say that death is near eliminates hope and there is a belief that it can hasten death

Decision making may lie within community or family rather than a patient-centered model that values autonomy

Attitude and experience of pain/suffering

Desire

for pain avoidance

is not

a universally

shared belief

Not all believe patient should be involved in decision making

Cultural Sensitivity

 ”In order to communicate respect for culturally different patients, it is important to assess the relevance of specific cultural values for a particular patient or family using cultural sensitivity” (Zager & Yancy 2011).

Cultural Competence

“lack of evidenced outcomes in which health disparities are indeed reduced through the implementation of cultural competence programs” (Chang & Dong, 2012)

Asking

culturally

sensitive questions to promote values and beliefs enhance cultural competence, ... education may increase clinician awareness of cultural differences among patients. (Zager & Yancy, 2011)

Bias:

An inclination of temperament or outlook: personal or unreasoned judgmentStereotype:

Assumption that all members of a group possess similar attributes

False assumptions

Broad generalizationsMisunderstanding

Poor communication

Generalizations and stereotyping lead to:

“Encourages individuals to identify their own biases and to acknowledge that those biases must be recognized. It is the “ability to maintain a stance that is other-oriented in relation to aspects of cultural identity that are most important to the [person]”

Cultural Humility

Elements of Cultural Humility

“Cultivate a reflective and humble mind”

Self-Questioning

acknowledge assumptions and beliefs that are embedded in our

own understanding, rather than delving into patient’s belief systemEvery patient encounter is a cross-cultural exercise – “even if you grew up on the same street”

Cultural Immersion

(Chang & Dong, 2012)

Elements of Cultural Humility

Learn from patients narrative without jumping to conclusions to avoid cultural stereotypingCultural

humility becomes not an end point but an active process of being in the world and being in relationships with others and self

“Cultivate a reflective and humble mind”

A life-long processActive listening

(Chang & Dong, 2012)

Asking culturally sensitive questions:

?

?

?

“When professional interpreters were not used, .... patients and families had inadequate understanding about diagnosis and prognosis during goals of care conversations, and patients had worse symptom management at the end of life, including pain and anxiety."

LANGUAGE MATTERS

(Silva et al., 2016)

•A caring stance can overcome almost anything•A continuous process based on

listening•Begins with self

REFERENCES

Chang, E., Simon, M., & Dong, X. (2012). Integrating cultural humility into health care professional education and training.

Advances in Health Sciences Education,

17(2), 269-278Giger, J. N., Davidhizar, R. E., & Fordham, P. (2006). Multi-cultural and multi-ethnic considerations and advanced directives: developing cultural competency. Journal of cultural diversity, 13

(1), 3

.

Hook, J. N., Davis, D. E., Owen, J., Worthington Jr, E. L., &

Utsey

, S. O. (2013). Cultural humility: Measuring openness to culturally diverse clients.

Journal of Counseling Psychology

,

60

(3), 353.

Kagawa-Singer

, M., & Blackhall, L. J. (2001). Negotiating cross-cultural issues at the end of life: you got to go where he lives.

Jama, 286(23), 2993-3001.Lubimir, K. T., & Wen, A. B. (2011). Towards cultural competency in end-of-life communication training. Hawaii medical journal, 70

(11), 239.Silva, M. D., Genoff, M., Zaballa, A., Jewell, S., Stabler, S.,

Gany, F. M., & Diamond, L. C. (2016). Interpreting at the end of life: a systematic review of the impact of interpreters on the delivery of palliative care services to cancer patients with limited english proficiency. Journal of pain and symptom management, 51

(3), 569-580.Tervalon, M., & Murray-Garcia, J. (1998). Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education.

Journal of health care for the poor and underserved, 9(2), 117-125.Zager, B. S., & Yancy

, M. (2011). A call to improve practice concerning cultural sensitivity in advance directives: a review of the literature. Worldviews on Evidence‐Based Nursing, 8(4), 202-211.