Blog Post

2 lessons from hospice on honoring patient and family cultural wishes

By Monica WestheadAliki KarnavasNadia Critchley

September 22, 2021

    Health care organizations have increasingly voiced a commitment to improving health equity in order to provide the best care possible. To date, most organizations have focused on ensuring equitable access for their communities and promoting the utilization of their services.

    While these are certainly important components of health equity, many organizations have skipped over one crucial aspect – providing care that meets the cultural and spiritual needs of their patients. 

    The hospice sector stands out in its experience honoring cultural and spiritual needs. Because hospice's role in the care continuum is to provide a comfortable, dignified end-of-life experience to patients and families, a large portion of hospice services are centered around meeting patient and family cultural and spiritual wishes. 

    These could range from a request for materials to be translated into their native language to having a specific prayer performed. Not only is this a major aspect of the care hospices provide, but it is also a major component of their quality reporting measures. Rates of communication with the family, treating the patient with respect, providing emotional and spiritual support, and asking patients and families about their beliefs and values are all publicly shared on Care Compare.

    Because of their expertise in honoring cultural and spiritual wishes at the end-of-life, the rest of the health care industry can look to hospice as a model for providing culturally sensitive care.

    Read on for two lessons the rest of the health care industry can learn from hospice about respecting patients' cultural and spiritual needs. 

    Lesson #1: Miscommunication of cultural and spiritual wishes most commonly occurs during periods of transition.

    Creating seamless care transitions has been a goal for the health care industry for a long time, but the focus has mainly been on the clinical aspects of care. Miscommunications of cultural and spiritual wishes are just as important to address and happen most frequently during instances of change. This could be a transition to a new care site, a change in the patient's condition, or a switch in staff. 

    Below are common times for miscommunications to occur:

    • When patients are admitted to a new site of care: Providers who don't specialize in hospice care often don't ask about cultural and spiritual wishes. Even if they do, there is no standardized way to communicate a patient's cultural and spiritual wishes to the patient's discharge destination. 
    • When transitioning between members of the care team: Non-hospice health care providers typically don't have a centralized place to incorporate the patient's cultural and spiritual data. Because of this, one provider may have the information while the rest of the care team does not. 
    • When the patient experiences a significant change in condition: Patients and families often avoid discussing the outcomes they fear—a dramatic downswing in the patient's condition or death. Because of this discomfort, family caregivers may not include or reveal what they want to occur if a significant deterioration occurs, or after the patient has died.  

    To provide culturally sensitive care to all patients, providers should make a point to ask about patients' cultural and spiritual wishes, especially during transition periods. Additionally, providers and caregivers should be notified that these times are most precarious and to take special care.

    Action step 1: Hardwire capturing the patient and family's cultural wishes into the care team's workflow

    Have patients and families fill out a standardized intake questionnaire that includes cultural and spiritual wishes. Ensure your staff is prepared to explain why the questionnaire asks these questions in case a patient expresses discomfort in sharing their beliefs. 

    Staff should emphasize the importance of the questions for the care team and that all patients are asked to fill out the same questionnaire. The answers to these forms should be kept in a place where all clinicians will see them, like in the EMR. 

    By elevating cultural and spiritual wishes to the same level of importance as a patient's clinical information, hospices can ensure staff are aware of the patient's wishes. Doing so also gives the organization the ability to act quickly if needed.

    For example, some cultures require burial to occur within 24 hours of death. Ensuring that this information is centralized allows staff to sign the death certificate immediately so the family can plan funeral arrangements on time. 

    Lesson #2: You cannot know everything about a patient's culture.

    When addressing health equity, most health care organizations have striven for cultural competency. This refers to a clinician's ability to deliver health care tailored to a patient's cultural and social context. Providers who focus on cultural competency look at differences between groups based on perceived group identity, which can inadvertently perpetuate stereotypes in these communities.  

    Instead of a cultural competency approach, hospice providers recognize they cannot know everything about a person's identity. Because of this, they adapt to respect and honor their patient's wishes, despite not being able to predict them. 

    Action step 2: Practice cultural humility

    Cultural humility shifts away from interacting with people who are considered "different" from a perceived group norm to acknowledging and appreciating the inherent value of others' perspectives and cultures. It recognizes that it's impossible to become an expert, or even competent, in a culture or lived experience that is not one's own.  

    Clinicians can provide culturally sensitive care by focusing on true person-centered care. A key component of patient-centered care is ensuring that providers build trust with the patient and have the initiative and flexibility to modify care plans. 

    Practicing cultural humility supports patient and family engagement when deciding on the patient's choices in care. This is particularly important in hospice given that it is end-of-life care and providers want patients to feel comfortable, supported and respected, but is still crucial across all levels of care. 

    Conclusion

    Providing the best care to individuals and communities requires providers to act on patient wishes and that includes their cultural and spiritual wishes. These two lessons and accompanying action steps will put providers on the right track to improving the patient experience and health equity.

    The case for cultural compassion

    Why traditional cultural competency models are insufficient and what to do moving forward

    groupTo better serve an increasingly diverse patient population and reduce existing health disparities, many organizations have implemented cultural competency models. However, the current model many provider organizations have embraced is insufficient, and arguably outdated. This approach can create a false sense of understanding an identity group, perpetuate biases, and promote stereotypes.

    Rather than striving for cultural competence, organizations should aspire to cultural humility. A cultural humility model—adopted at the institution and clinician level—better positions organizations to have a significant impact on building trust, supporting patients’ engagement in their care, and improving outcomes. Learn the four steps organizations can take to make the shift, in mindset and action, from cultural competence to cultural humility.

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