Continuing Education—February 2012
Cultural Awareness in EOL Care: Annotated Bibliography, pt. 1
This is the first of a series of annotations on articles of interest to Duke Hospice volunteers with
questions, concerns, or interest in providing culturally sensitive care to their patients and
caregiving families. The full articles may be found in the Volunteer Services Library at the main
Duke HomeCare and Hospice office in Durham. Please contact Carolyn Colsher for assistance.
If you are aware of articles, chapters, or books that should be added to this list, please let Carolyn
know.
1
Author
Title
Citation
Target group(s)
Crawley, LaVera;
Marshall, Patricia; Lo,
Bernard; Koenig,
Barbara
Strategies for
Culturally Effective
EOL Care
2002, Ann Intern
Med, 136: 673-679
Latino American, AA
Fiorelli, Robin, and
Jenkins, Wanda
Cultural Competency
in Grief and Loss
NHPCO NewsLine
General
Kagawa-Singer,
Marjorie, and
Blackhall, Leslie J.
Negotiating CrossCultural Issues at the
EOL
2001, JAMA, 286(23),
2993-3001
AA, CA
Kemp, Charles
Cultural Issues in
Palliative Care
2005, Seminars in
Oncology Nursing,
21(1), 44-52
General
Notes
Directed toward physicians working with pts at EOL.
Uses case studies of (1) Advance Directives in a
Spanish-speaking Woman Pt with Congestive Heart
Failure and (2) Insistence on Life-Sustaining
Interventions by an AA Male Pt with Metastatic
Cancer. Headings: Strategies for Cross-cultural EOL
Care; Basic Concepts of Culturally Effective Care
Guidelines for providing bereavement support to
individuals from a different culture than your own:
think of yourself as a guest in their world; ask about
their customs and traditions; identify the degree of
acculturation and assimilation the individual appears
to have toward the dominant culture; assess the
degree of involvement with both the culture of origin
and the host culture; ask leading questions; be
present.
Studies have shown cultural differences in attitudes
toward truth telling, life-prolonging technology, and
decision-making styles at the EOL. Using 2 case
studies, the authors outline some of the major issues
involved in cross-cultural care and indicate how the
patient, family, and clinician can navigate among
differing cultural beliefs, values, and practices.
Practical advice for learning about cultures (through
literature, contacts in the community, the pt and
family); common issues at EOL and possible
interventions (unique differences, experiential issues,
language / cultural barriers, resolving relationships,
decision-making, family involvement in care, religion
and faith, involvement of clergy, life support and
advance directives, suffering, expression of pain,
meaning of death and dying, immediate after-care,
autopsy and organ donation, disposal of the body,
2
Lopez, Sandra
Honoring Cultural
Diversity at the EOL
2007, Social Work
Today, 7(6), 36
General
Mazanec, Polly, and
Tyler, Mary Kay
Cultural
Considerations in
End-of-Life Care
2003, American
Journal of Nursing,
103(3), 50-59
AA, CA, Filipino
American, Hispanic/
Latino American
Perkins, Henry et al.
Cross-cultural
Similarities and
Differences in
Attitudes about
Advance Care
Planning
Approaching the End
of Life: Attitudes,
Preferences, and
Behaviors of AfricanAmerican and White
Patients and Their
Family Caregivers
A Crack Between the
Worlds
2002, J Gen Intern
Med, 17: 48-57
Mexican-American,
Euro-American, AA
2003, J of Clin
Oncology, 21(3), 549554
AA, White
1995, Commonweal,
122(18), 13
Mexican
Communication
2011, Culture Clue for
All Cultures
Phipps, Etienne et al.
Roy, Ann
U of Washington MC
grief and bereavement
Major Cultural Considerations and EOL Care: pt’s
perceptions of health and suffering; pt’s perceptions
of death and dying; perceptions of healthcare
providers, healthcare, and hospice; accepted
healthcare practices and remedies; accepted religious
and spiritual beliefs, practices, and rituals;
communication patterns and common forms of
expression; the role of family, relationships, and
family involvement; and problem-solving, decisionmaking and help-seeking behaviors.
Directed toward nurses working with pts at EOL.
Headings: Developing Cultural Competence (Barriers
to cultural competence); Components of Culture:
Ethnic Identity; Components of Culture: Age;
Components of Culture: Spirituality; Culturally
Controversial Issues
Majorities of all 3 groups studied believed “the pt
deserves a say in treatment” and “advance directives
improve the changes a pt’s wishes will be followed,”
but disagreed about (among other things) who
controls treatments, whether the medical system can
be trusted.
Directed toward physicians working with pts at EOL.
68 AA and white cancer pts and caregivers
interviewed re: EOL preferences. Disagreements
between pts and families about the use of lifesustaining measures in pts without Living Wills may
result in pts’ preferences being superseded at EOL.
Focuses on the Mexican concept of death, Day of the
Dead celebrations; link between life and death;
contrast with the American concept of death.
Directed toward clinicians at UWMC. Headings: Help
3
Valente, Sharon M.
AA=
CA=
Guide: All Cultures
Clinicians
End of Life and
Ethnicity
2004, Journal for
Nurses in Staff
Development, 20(6),
285-293
General
Your Patients Feel Comfortable; Establish a
Relationship with Your Patients; Provide Health
Information in Ways Your Patients Accept; Maintain
Good Communication with Your Patients; Show Your
Patients Respect
Directed toward nurses working with pts at EOL.
Headings: Impact of Culture on EOL Choices; Content
of EOL Care; Influence of Culture and Ethnicity on
Attitudes toward Death; Ethnicity and Advance
Directives; Use of Hospice; Implications and Clinical
Challenges; Symptom Management; Nursing
Education; Toolkits for EOL Education
African American
Chinese American
4