More than words
Death is difficult in any language. But that doesn’t mean we can take a one-size-fits-all approach to end-of-life care.
With rising population trends in ageing, chronic illness and migration, the need for palliative care for culturally and linguistically diverse (CALD) populations is growing. In the 2016 census, there were over 300 separately identified languages spoken in Australian homes; with 819, 922 people reporting they had difficulty speaking English.*
Although there has been significant development of specialist palliative care services within New South Wales, there is little information available at the patient level on the type and quality of care provided.
Dr Anna Green and Professor Elizabeth Lobb reviewed the clinical journeys of patients from culturally and linguistically diverse backgrounds, and the experience of palliative care providers for this population, to fill this gap.
The study showed that there were some universal concerns across cultural groups such as a fear of dying and accompanying taboos around death. Yet the overall approach to patient care was seen as a careful balancing act between the needs of the individual and the needs of the family in palliative care. The role of family members as mediators between patients and providers conflicts with the Western medical emphasis on patient independence. Professor Lobb /Dr Green say it’s important in this context that Western outlooks on ethics work alongside cultural ideals without stereotypes or oversimplification.
“The participants in the study perceived that cultural and linguistic backgrounds need to be considered within individualistic care. This is important in ensuring that generalisations and assumptions based on providers’ knowledge of different cultures don’t adversely impact individual patients,” said Professor Lobb.
Another key finding of the study was the importance of establishing a feeling of trust between patient and carer. This trust could be built by respecting cultural differences and considering how potential traumas relating to patients’ experiences of migration may influence care. Trust was often improved when care providers took the time to attempt communication and found staff members who spoke the same language to enhance understanding.
“When we’ve found [staff member] from a same speaking background to come up and understand the basic things, their face lights up, that ‘thank goodness I can be heard, I’m understood and I can have some sort of comfort from that’,” said a nurse.
Thus, raising the awareness of palliative care providers about how to accommodate cultural beliefs in provision of care should involve tailoring of education and information in collaboration with CALD communities. “We think that there is a need to implement education strategies, such as workshops to raise awareness and knowledge of the role of professional interpreters for palliative care providers,” says Dr Green.
*Source: .id demographic resources