Cultural Preferences and End-of-Life Care

As difficult as it may be to address the needs of patients and their families around informed consent and end-of-life care, the challenges can be greater still when patients and their families do not share the same cultural beliefs or background as their health care providers.

In this Discussion, you will examine attitudes and preferences around end-of-life care common in African-American, Latino, Asian, Caucasian, or other communities, and discuss how health care providers and administrators can ensure that care is delivered in an ethically and legally competent manner, taking into account possible cultural differences.

To prepare for this Discussion:

• Review the following assigned articles, and select one of the cultural/ethnic groups described in them to focus on in your initial posting. (Note:You will select a colleague's posting on a different group for your response.)
  • "Negotiating Cross-Cultural Issues at the End of Life"
  • "Palliative Care for Latino Patients and Their Families"
  • "A Literature Review of Preferences for End-of-Life Care in Developed Countries by Individuals With Different Cultural Affiliations and Ethnicity"
• Identify characteristic attitudes and preferences of the cultural group regarding end-of-life care, including informed consent, life support, advance directives, and communication and/or decision-making styles, as described in these articles. Do further research, as needed, to fill out your understanding of this selected group's end-of-life preferences. As you develop this understanding, however, remember that attitudes and preferences which may be generally characteristic of a group are not necessarily shared to the same extent by every member of the group.
• How might these factors translate into sources of misunderstanding or frustration in interactions between health care personnel and patients and their families? Consider ethical and legal challenges providers might encounter as they attempt to explain end-of-life options to a patient and his or her family. Also bear in mind that cultural differences can arise whether it is the patient or a health care professional who holds attitudes reflective of one of these communities.

By Day 4, post a response to the following:

• Identify the cultural/ethnic group you have selected.
• Summarize significant findings about this group that inform attitudes and preferences around end-of-life care (e.g., informed consent, life support, advance directives, communication styles, and/or decision making, etc.), and cite your sources of information.
• What are the challenges in ensuring that patients (or their surrogates) understand their rights and that their consent is truly informed?
• What are the legal/ethical implications of these challenges for administrators? How can they help prevent cultural misunderstandings or discrimination, and address problems when they do they arise?

Read a selection of your colleagues' postings.

Articles mentioned in the discussion question:

• Article: Kagawa-Singer, M., & Blackhall, L. J. (2001). Negotiating cross-cultural issues at the end of life: "You got to go where he lives."JAMA: Journal of the American Medical Association, 286(23), 2993-3001. Retrieved from the Walden Library databases.
  This article discusses cross-cultural issues arising in end-of-life care, using two cases-one an African-American male, and the other, a Chinese-American female-to illustrate.
• Article:Smith, A. K., Sudore, R. L., & Pérez-Stable, E. J. (2009). Palliative care for Latino patients and their families: Whenever we prayed, she wept.JAMA: Journal of the American Medical Association,301(10), 1047-1057. Retrieved from the Walden Library databases.
  This article describes obstacles that can be encountered by Latinos in obtaining quality end-of-life care.