June 2017:  Just as Cultures Vary, So Do End-of-Life Issues

American society is highly diverse - New Jersey, where we operate, takes pride in our high level of diversity. We are blessed with neighbors from around the globe, representing various cultural, ethnic and religious backgrounds.

Health care providers are learning the importance of being sensitive to different people’s beliefs and feelings about illness, pain and end-of-life. When it comes to providing hospice and palliative care, serving a diverse patient population requires delicacy and cultural competency to best serve people with a broad range of values, beliefs and customs that may differ from our own. Taking care of patients’ needs at this critical time must also include the awareness of and respect for differing experiences—religious, cultural, ethnic—around chronic or serious illness and death and dying.

Diversity may extend to personal behaviors and beliefs that are outside of heritage; one person’s show of strength may carry him/her through a difficult time while another may find comfort in leaning on others. Social workers, aides and nurses who take care of hospice patients also work closely with caregivers and family members; being cognizant of these diverse views of illness, death and dying is of the utmost importance.

There are differing customs around preparing a person for death—mind, body and soul—and how the family members should comfort themselves during this intense time. For example, some cultures shun away from full disclosure about a person’s health condition. Others prefer the family to make all care decisions on behalf of the patient. Some people believe that death is an inevitable and natural part of life’s journey and accept it without consequence. Others may balk at the notion of withholding “heroic measures” at the end of life or believe that talking about dying is taboo. There are people who find comfort and solace in quiet prayer and rituals; others may prefer sharing their concerns or thoughts with a mental health professional.

Cultural factors as well as religious or spiritual beliefs and practices may influence key decisions by patients and their loved ones regarding palliative and hospice care in several important areas, among them:

- Perception of health or disease
- Approach to pain management
- Perception or beliefs about death and dying
- How the patient sees healthcare providers
- Types of healthcare practices and treatments the patient seeks or prefers
- Forms of communication and what should be discussed or kept private
- Acceptance of the importance or role of the advance medical directive and durable power of attorney
- Where one’s final days should be spent
- Understanding of hospice care and what it offers—and where it can be provided

The clinical team at the Center for Hope understands that patients and their families are facing extraordinary circumstances, regardless of their background, country of origin, religious beliefs or cultural norms. They also understand that each person must be treated with respect and with affirming, supportive care.

Providing quality hospice care and pain management must always be balanced with the individual’s needs and concerns, and with sensitivity to each person’s beliefs, customs and preferences. Serving so many people from our area’s diverse cultures helps us improve delivery of care and expand our own horizons while enriching us every day.