Despite the many benefits of palliative care for seriously ill people and their families, cultural differences such as language or deeply held beliefs about discussing end of life often create barriers to receiving palliative support among certain racial and ethnic groups.
Given society’s increasing diversity, it’s critical to have culturally competent palliative care clinicians and organizational policies designed to reduce barriers and improve access to culturally diverse groups. In turn, we’ll see improved relationships between care teams and patients, better health outcomes, higher-quality care, and lessened racial and ethnic health disparities.
Addressing Language Barriers
Overcoming language barriers is vital for conducting effective communication across many areas – including medication education, symptom management, advance care planning, and other domains of palliative care. In many cases, this is not a matter of convenience — it is critical for the care team to speak the language of their patient rather than relying on family members or others to interpret for them.
For example, the care team at Turn-Key Health, a CareCentrix company, worked with a Spanish-speaking individual with whom they had trouble communicating during his initial palliative nursing assessment due to the language barrier. The team attempted to communicate through a language line, but schedule coordination challenges with the interpreter and the family made this impractical.
Recognizing the challenges, the Turn-Key Health care team altered their approach, securing a dedicated interpreter from the language line to assist the patient while seeking to add a Spanish-speaking clinician to their team. With the help of the interpreter, the palliative care team identified his needs and was able to help him obtain equipment to increase his independence, apply for Medicaid, and receive support for his caregiver. Subsequently, a Spanish-speaking nurse was hired and became the patient’s primary care nurse, who he entrusted to assist in advance care planning. This nurse is now available to Spanish-speaking patients and caregivers moving forward.
Opportunities to Overcome Cultural Barriers
A lack of training in cultural competency among palliative care providers, along with some culture’s belief systems in discussing end of life or placing limits on treatments, creates barriers to palliative care for some minority groups. To improve access, health systems and clinicians providing palliative services should recognize and respect differences, while striving to meet the holistic needs of individuals and family caregivers. In addition, steps should be taken to prioritize education, payment, and health equity reforms to support interdisciplinary palliative care team members and help identify and resolve social, financial, environmental, and emotional challenges facing patients and caregivers across all ethnic and racial groups.
Palliative care plays an important role in addressing health disparities, and we can do more to ensure culturally competent care is available to all.
Role of Home-Based Palliative in Promoting Equitable Care
Home-based palliative care—the provision of home visits by specially trained healthcare professionals, including nurse practitioners, registered nurses, social workers, and others—offers an opportunity to narrow disparities and promote more equitable health services. By providing culturally inclusive home-based care and getting to know patients and their caregivers in their homes, care teams are able to deliver high-quality person, family, and community-centered services.
When visiting people in their homes, care teams gain insight into the social determinants that may be impacting the individual’s health. This understanding lays the groundwork for open communication and builds long-term trust between in-home care teams, patients and caregivers, ultimately allowing them to address these issues in a way that further enhances the relationship and improves quality of care.
Caring for people in their homes also deepens the patient-provider relationship, enabling the care team to engage patients in sensitive discussions about goals of care so that the patient and family receive a tailored care plan that best aligns with their wishes. During a uniquely challenging time of life, diverse home-based palliative care teams and culturally sensitive practices, like the ones deployed in Turn-Key Health’s home-based palliative care program, play a crucial role in delivering effective, culturally fulfilling, whole-person care when it’s needed most.
Read more about culturally appropriate palliative care from Turn-Key Health in McKnight’s Senior Living publication.
Additional Reading
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