How do intensive care clinicians ensure culturally sensitive care for family members at the end of life? A retrospective descriptive study

Abstract

IntroductionPatients and their family members have diverse needs at the end of life, influenced by culture. ObjectiveTo examine whether clinicians (doctors and nurses), provided culturally sensitive care for family members of patients from culturally diverse backgrounds who died in an intensive care unit. MethodsA retrospective medical record audit was undertaken in four metropolitan intensive care units in Melbourne, Australia. Quantitative data are reported using descriptive statistics. Qualitative progress note entries are presented using themes. ResultsIn all, 430 patients died in 2018 and were included in the audit. Almost half of patients (47.9%, n = 206) were born in Australia, with the remaining 52.1% (n = 224) representing 41 other countries of birth. Languages other than English were spoken by 14.9% (n = 64) of patients. Christian religions were most common (50.2%, n = 216), followed by Buddhism 3.0% (n = 13), and Hindu and Islam respectively (1.9%, n = 8). A cultural assessment was undertaken in 10.5% (n = 45) of cases, mostly by social workers, to ascertain family members’ wishes and preferences for the dying patient’s end-of-life care. Religious leaders (eg. priests) (25.1%, n = 108) and interpreters (4.9%, n = 21) contributed to ensuring family members could participate as desired, in accordance with cultural wishes and preferences. ConclusionsDespite the culturally-diverse patient population, findings show that details about culturally sensitive end-of-life care are rarely documented. Comprehensive documentation is required of how clinicians assess patient and family member cultural wishes and preferences, in conjunction with how clinicians attempt to address these cultural needs.