Overview of cultural considerations in palliative care

Culturally responsive palliative care reflects an understanding of a patient’s cultural identity and the degree to which that influences their treatment decisions. Patients sometimes have different explanations for, and perceptions of, illness or death from those proffered by Western healthcare professionals. Beliefs and practices about death and dying should be identified and respected, including:

• family participation
• gender roles
• communication preferences guiding decision-making and the breaking of bad news
• bereavement
• rituals.

When a healthcare professional is unfamiliar with the cultural norms of a particular ethnic or religious group, it is helpful to ask the patient or family, or to seek information from government agencies, national clubs or organisations, or community leaders. Interpreters may also play a role in conveying cultural values and preferences to healthcare professionals. While it is important to be aware of this information, avoid stereotyping people as individual beliefs and preferences may differ.

Good communication, explanation and reassurance about treatment decisions is essential. It may be helpful to offer alternative options if possible: for example, for patients who have concerns about the use of injections or opioid therapy. It may be necessary to involve interpreters, cultural liaison workers or advocates from the patient’s community to assist and ensure that the information is understood.

Many cultural groups place importance on involvement of family and community members in decision-making. Family meetings provide an important forum for communication of information, culturally responsive decision-making and practical care planning. Family considerations and cultural factors often determine where the patient will be best managed and who might be the best person to administer medications at the end of life without incurring blame for a patient’s death. The appropriate person to accompany and care for a patient may also change at different stages of the patients’ journey (eg the decision-maker before death may be different to the decision-maker about funeral and ceremony arrangements).

Palliative care resources for patients and families from culturally and linguistically diverse backgrounds are available at CareSearch.