Abstract
BackgroundMultiple factors influence the end-of-life (EoL) care and experience of poor quality services by culturally- and spiritually-diverse groups. Access to EoL services e.g. health and social supports at home or in hospices is difficult for ethnic minorities compared to white European groups. A tool is required to empower patients and families to access culturally-safe care. This review was undertaken by the Canadian Virtual Hospice as a foundation for this tool.MethodsTo explore attitudes, behaviours and patterns to utilization of EoL care by culturally and spiritually diverse groups and identify gaps in EoL care practice and delivery methods, a scoping review and thematic analysis of article content was conducted. Fourteen electronic databases and websites were searched between June–August 2014 to identify English-language peer-reviewed publications and grey literature (including reports and other online resources) published between 2004–2014.ResultsThe search identified barriers and enablers at the systems, community and personal/family levels. Primary barriers include: cultural differences between healthcare providers; persons approaching EoL and family members; under-utilization of culturally-sensitive models designed to improve EoL care; language barriers; lack of awareness of cultural and religious diversity issues; exclusion of families in the decision-making process; personal racial and religious discrimination; and lack of culturally-tailored EoL information to facilitate decision-making.ConclusionsThis review highlights that most research has focused on decision-making. There were fewer studies exploring different cultural and spiritual experiences at the EoL and interventions to improve EoL care. Interventions evaluated were largely educational in nature rather than service oriented.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-016-0282-6) contains supplementary material, which is available to authorized users.
Highlights
Multiple factors influence the end-of-life (EoL) care and experience of poor quality services by culturallyand spiritually-diverse groups
Potential factors explaining these disparities include different conceptualizations of palliative care (PC); varied beliefs and attitudes between healthcare providers (HCPs) and ethnic minority patients; socioeconomic status; lack of healthcare coverage, gendered beliefs and responsibilities, [17] and historical contexts shaped by colonialism that impacted health beliefs and understandings of Aboriginal peoples [21]
Seven frameworks and guides recommended for providing care for culturally- and spiritually-diverse persons approaching EoL and their family members explained the dynamic nature and the similarities between different cultural traditions as well as strategies for shared decision-making between providers and service users to overcome barriers at the patient, system- and societal-levels [68, 116,117,118,119,120,121]. Two examples of such frameworks involve: (i) transcultural nursing concepts that aid hospice providers with assessments and interventions in multicultural situations [117] and (ii) strategies to bridge communication between terminally-ill patients and their family members with HCPs [119]. Findings from this scoping review highlight a multitude of factors influencing the receipt of poor quality EoL care and subsequent experiences by culturally- and spiritually-diverse groups
Summary
Multiple factors influence the end-of-life (EoL) care and experience of poor quality services by culturallyand spiritually-diverse groups. Access to EoL services e.g. health and social supports at home or in hospices is difficult for ethnic minorities compared to white European groups. A tool is required to empower patients and families to access culturally-safe care. Research reveals that access to EoL services such as health services and social supports either at home or in hospices are low among ethnic minorities living in Western societies when compared to white populations [2, 3]. There are multiple factors that influence low-uptake of and lack of sensitivity in EoL care that contribute to poor quality service experiences of culturally- and spiritually-diverse groups [4]. Key barriers to EoL care include: cultural differences between healthcare providers (HCPs) and persons approaching EoL, patients and families [5]; underutilization of culturally-sensitive models designed for improved EoL care [6]; language barriers [7]; lack of awareness of cultural and spiritual diversity issues; exclusion
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