Ethnicity as a Factor

2015 ◽  
Author(s):  
Kimberly S. Johnson ◽  
Ramona L. Rhodes
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
African Americans ◽  
Health Care Providers ◽  
Cultural Beliefs ◽  
Ethnic Disparities ◽  
Care Providers ◽  
Care Services ◽  
Palliative Care Services ◽  
Advance Care

This chapter examines how race or ethnicity affects access to, and the quality of, palliative care by focusing on the experience of African Americans and Hispanics. More specifically, it considers how cultural beliefs, values, and preferences may influence care. It begins by looking at racial and ethnic disparities that exist throughout the health-care continuum, from disease prevention, early diagnosis, and curative treatment, to communication and pain management, lower rates of advance care planning, and lower utilization of hospice and palliative care services. It then explores the preferences of African Americans and Hispanics when it comes to end-of-life care, as well as the role of spirituality and faith in how they cope with illness. The chapter concludes by suggesting strategies and future directions for health-care providers, organizations, policymakers, and researchers on how to improve care for patients of diverse racial and ethnic backgrounds.

Awareness as a dimension of health care access: exploring the case of rural palliative care provision in Canada

2019 ◽  
Vol 24 (2) ◽  
pp. 108-115 ◽  
Author(s):  
Arlanna Pugh ◽  
Heather Castleden ◽  
Melissa Giesbrecht ◽  
Colleen Davison ◽  
Valorie Crooks
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Health Care Providers ◽  
Care Delivery ◽  
Local Health ◽  
Care Providers ◽  
Five Dimensions ◽  
Care Services ◽  
Palliative Care Services ◽  
Communication And Coordination

Objectives In Canada, the rural elderly population is increasing in size, as is their need for palliative care services in these settings. This analysis aims to identify awareness-associated barriers to delivering rural palliative care services, along with suggestions for improving service delivery from the perspective of local health care providers. Methods A total of 40 semi-structured interviews with various formal and informal health care providers were conducted in four rural and/or remote Canadian communities with limited palliative care resources. Interview data were thematically coded using Penchansky and Thomas’ five dimensions of access (i.e. availability, (geographic) accessibility, accommodation, acceptability and affordability). Saurman’s recently added sixth dimension of access – awareness – was also identified while coding and subsequently became the primary focus of this analysis. Results Identified barriers to palliative care awareness and suggestions on how to enhance this awareness, and ultimately palliative care delivery, corresponded with three key themes arising from the data: limited palliative care knowledge/education, communication and coordination. Participants recognized the need for more palliative care education, open lines of communication and better coordination of palliative care initiatives and local resources in their communities. Conclusions These findings suggest that identifying the barriers to palliative care awareness in rural communities may be foundational to addressing barriers to the other five dimensions of access. A thorough understanding of these three areas of awareness knowledge, communication and coordination, as well as the connections between them, may help enhance how rural palliative care is delivered in the future.

Policy in palliative care

2015 ◽  
Author(s):  
David C. Currow ◽  
Stein Kaasa
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Health Care Providers ◽  
World Health ◽  
Care Providers ◽  
Care Services ◽  
Palliative Care Services ◽  
Organization Policy ◽  
Health Organization ◽  
Hospice Palliative Care

Hospice and palliative care services have developed in very different ways around the world. Most have been built on the momentum of visionary clinicians and funders who have responded to perceived needs from health-care providers, patients, families, and communities rather than in response to well-formed national policies with an adequately funded planning and development phase. This chapter describes the work that is being done at pan-national, national, and sub-national levels to create effective policies that can further the key work of hospice/palliative care, often after a large number of apparently unconnected local services have been well established. The chapter highlights that there are particular challenges in forming public policy on hospice/palliative care, especially the end-of-life component, and notes the importance of ‘patients’ voices’-the voice of the community which helps to inform health policies including end-of-life care. The chapter ends by describing a variety of country-specific and World Health Organization policy documents and legislation.

Family Conference in Palliative Care

2018 ◽  
Author(s):  
Margaret L. Isaac ◽  
J. Randall Curtis
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Health Care Providers ◽  
Care Providers ◽  
Therapeutic Communication ◽  
Missed Opportunities ◽  
Patient Navigators ◽  
Family Conference ◽  
Advance Care ◽  
End Of Life Decision

Patients receiving palliative care often experience severe psychosocial distress, which may due to the perception of the situation, the community resources and support, educational level, comorbidities, coping skills, and socioeconomic status. However, the distress can be reduced by communication between patients, caregivers, and health care providers. Studies have shown that family conferences can be a safe and well-accepted means for communication between patients, caregivers, and health care providers in the palliative care setting. This chapter highlights key topics regarding the family conference and facilitation of patient–clinician communication in palliative care. The topics covered in this chapter include (a) key components of a family conference (e.g., the importance of listening, therapeutic communication, and missed opportunities), (b) proactive communication strategies in the intensive care unit, (c) use of patient navigators and communication facilitators to reduce family distress, and (d) the impact of advance care planning on end-of-life decision-making regarding resuscitation.

Case Study: Trisomy 13, A Palliative Care Case

2009 ◽  
Vol 28 (4) ◽  
pp. 263-266
Author(s):  
Jennifer Wirth
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Health Care Providers ◽  
Patient Population ◽  
Family Relationship ◽  
Disease Diagnosis ◽  
Trisomy 13 ◽  
Care Providers ◽  
Palliative Care Services

PALIATIVE CARE IS AN IMPORTANT piece of the health care puzzle, one that is being utilized more frequently to provide excellent patient care throughout the life span. Although the need for palliative care services among the NICU patient population is often overlooked, this fragile patient population would at times greatly benefit from these services. It is vital that health care providers be aware of, knowledgeable about, and active in recognizing the need for palliative care referrals. This case study, from a nurse’s perspective, focuses on a patient diagnosed with trisomy 13 shortly after birth. It discusses the patient’s demographics and history, his disease/ diagnosis, and the nursing process surrounding the case, as well as the nurse-patient-family relationship and an evaluation of what was accomplished.

Access to palliative care services for limited English proficient patients with advanced NSCLC.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 99-99
Author(s):  
Bonnie Leung ◽  
Selina Wong ◽  
Kiran Malli ◽  
Cheryl Ho
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Median Time ◽  
Advanced Nsclc ◽  
Care Providers ◽  
Do Not Resuscitate ◽  
Care Services ◽  
Significant Difference ◽  
Palliative Care Services ◽  
Nsclc Patients

99 Background: More than a quarter of people living in British Columbia, Canada speak languages other than English in their homes. Immigrants often encounter communication challenges with their health care providers (HCPs), have poor health literacy, and have a limited understanding on navigating the health care system. NSCLC patients with limited English proficiency (LEP) may receive less palliative care services despite high symptom burden and significant needs due to these factors. The study goals were to observe the difference in access to community palliative home care (CPHC) and rate of completing a Do Not Resuscitate (DNR) form between NSCLC patients who are English proficient (EP) and LEP. Methods: All patients with advanced NSCLC referred to BC Cancer–Vancouver Centre in 2016 and received medical care were included (N=176). Patients seen with a medical interpreter were considered to be LEP. Demographics and clinical information were collected retrospectively. UVA using X2 test and Fisher’s exact test were used to compare EP and LEP patients. Mann-Whitney test was used to compare the median time from CPHC referral and signed DNR to death between EP and LEP patients. Results: Language of communication: English 65%, Cantonese 22%, Mandarin 6%, Korean 1%, Tagalog 1%, and other 5%. Baseline characteristics: median age 69 EP vs 76 LEP, female 44% EP vs 65% LEP, non-squamous 68% EP vs 72% LEP and squamous 14% EP vs 6% LEP. There was no difference in the rate of CPHC referral (87% EP vs 80% LEP, p=0.342) and signed DNR form (92% EP vs 89% LEP, p=0.549). The median time from CPHC referral to death was 10 weeks EP vs 15 weeks LEP (p=0.039). The median time from signed DNR to death was 5 weeks EP vs 6 weeks LEP (p=0.806). There was no statistically significant difference in location of death between the two groups: acute care 20% EP vs 24% LEP, home 27% EP vs 13% LEP, hospice 36% EP vs 39% LEP, and tertiary palliative care unit 17% EP vs 24% LEP (p=0.251). Conclusions: EP and LEP patients with NSCLC had similar rates of CPHC service referrals and end of life planning. This suggests assistance of medical interpreters at the time of oncology visits help message delivery between LEP patients and HCPs. LEP patients had earlier referrals to CPHC prior to death which may reflect an enhanced awareness and effort by HCPs to have earlier conversations with patients who may have language and cultural barriers with discussing goals of care. Good communication improves patients and their family’s understanding of the goals and scope of palliative care services and allow HCPs to better understand the patients’ wishes.

scholarly journals Insights from the Northern Territory on factors that facilitate effective palliative care for Aboriginal peoples

2009 ◽  
Vol 33 (4) ◽  
pp. 636 ◽  
Author(s):  
Emma L Phillips ◽  
Pam D McGrath
Keyword(s):  
Palliative Care ◽  
Health Care Providers ◽  
Health Professionals ◽  
Traditional Healers ◽  
Cultural Safety ◽  
Aboriginal Peoples ◽  
Care Providers ◽  
Remote Communities ◽  
Care Services ◽  
Palliative Care Services

This article aims to assist remote communities to develop their own palliative care services by providing findings on successful strategies identified through a 2-year research project which developed an innovative model for Indigenous palliative care. The discussion is set in the context of an understanding of the notion of cultural safety and discusses the positive experiences of the benefits of palliative care from the perspectives of both consumers and health professionals. The findings show that successful outcomes are derived from generic factors associated with palliative care philosophy and practice and from more specific factors, including the provision of pragmatic support to overcome practical problems, and community visits by health professionals. Factors specific to cultural respect are important, including familiarity and continuity of health care providers, cultural respect for grieving practices, provision of comfort food and bush tucker, development of culturally appropriate built environments, use of traditional healers and respect for spiritual practices.

scholarly journals Palliative Care Knowledge and Planning in U.S. Adults

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 778-779
Author(s):  
Amy Albright ◽  
Rebecca Allen
Keyword(s):  
Palliative Care ◽  
Health Literacy ◽  
Ethnic Disparities ◽  
Limited Range ◽  
Functional Health ◽  
Care Services ◽  
Palliative Care Services ◽  
Advance Care ◽  
Knowledge Scale ◽  
Post Hoc

Abstract Palliative care knowledge and health literacy are frequently underestimated in American adults; for example, as measured by the Newest Vital Sign (Weiss et al., 2005), 79.2% (n = 247) of participants within a Geriatrics Clinic sample displayed “adequate” functional health literacy, while 11.8% (n = 37) scored within the “possibly limited” range, and 9.0% (n = 28) scored within the “highly limited” range. There was additionally a significant association between health literacy and age (r = .15, p < .01) within this sample. The Palliative Care Knowledge Scale (PaCKS; Kozlov et al., 2018) was administered to participants, and higher scores indicated a greater knowledge of palliative care. This construct is particularly important to measure, as racial/ethnic disparities exist within this domain; for example, African Americans may have lower overall knowledge of palliative care services and advance care planning than non-Hispanic Whites (Noh et al., 2018). In the current study, knowledge of palliative care was measured using the PaCKS (Kozlov et al., 2018), and scores represented the widest possible range of 0 to 13 (M = 7.68, SD = 4.08). There was a significant correlation between age and PaCKS score (r = .12, p < .05), as palliative care knowledge increased with age. Females scored significantly higher (M = 8.29, SD = 3.91) than males (M = 6.81, SD = 4.18), t(309) = 3.18, p < .001. There was no main effect of race on palliative care knowledge, and post-hoc analysis using Tukey HSD did not demonstrate significant differences between groups.

Palliative medicine and care of the elderly

2015 ◽  
Author(s):  
Meera Agar ◽  
Jane L. Phillips
Keyword(s):  
Palliative Care ◽  
Health Care Providers ◽  
Adult Child ◽  
The Elderly ◽  
Adverse Outcomes ◽  
Care Providers ◽  
Older Person ◽  
Medical Problems ◽  
Care Services ◽  
Palliative Care Services

Palliative care in the older person occurs in the context of chronic disease and multimorbidity. Coexisting conditions include musculoskeletal, psychiatric, cognitive, and chronic pain-related problems, each associated with substantive symptomatology and disability. Most crucial is to avoid management within disease ‘silos’ and the risks associated with polypharmacy, which both contribute to adverse outcomes. The complexity of older people’s care demands the formation of a collaborative partnership between primary care, geriatric, and palliative care services, together with other health-care providers in accordance with need. The caregiver of the older person warrants specific mention, often an older spouse with their own medical problems or an adult child juggling other life and work commitments. Planning for care in advance is crucial to avoid decisions being made in crisis, and is particularly crucial if cognitive decline is predicted. Physiological changes, and the frequency of falls, frailty, depression, and delirium are important when planning care and prescribing.

scholarly journals Muslim perspectives on advance care planning: a model for community engagement

2021 ◽  
Vol 15 ◽  
pp. 263235242199715
Author(s):  
Alya Abbas Heirali ◽  
Sidra Javed ◽  
Zaheed Damani ◽  
Rahim Kachra ◽  
Sabira Valiani ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Provider ◽  
Health Care Providers ◽  
Advance Care Planning ◽  
Care Provider ◽  
Cultural Beliefs ◽  
Care Planning ◽  
Care Providers ◽  
Future Health ◽  
Advance Care

Background: Advance care planning is the process of communicating and documenting a person’s future health care preferences. Despite its importance, knowledge of advance care planning is limited, especially among the Islamic community. In addition, little is known about how the Islamic community views advance care planning in the context of their religious and cultural beliefs. Objectives: We aimed to increase knowledge of the importance of advance care planning, to improve health care provider and public knowledge, and to encourage dialogue between the community and health care providers. Methods: We organized a community event and assembled a multi-disciplinary panel. Through a moderated discussion, the panel members offered their perspectives of advance care planning within a Muslim context. Results: Approximately 100 individuals attended the event including community members, health care providers, medical students, and faith leaders. More than 90% of respondents rated the event as very good or excellent, found the session useful and were encouraged to reflect further on advance care planning. Conclusion: This event was successful in raising awareness about advance care planning within the Islamic community as well as educating health care providers on Islamic views. This model of community and health care provider engagement may also be beneficial for other faith groups wishing to discuss advance care planning within their respective religious and cultural contexts.

Overcoming Barriers to Access and Utilization of Hospice and Palliative Care Services in African-American Communities

2005 ◽  
Vol 50 (2) ◽  
pp. 151-163 ◽  
Author(s):  
Carole A. Winston ◽  
Paula Leshner ◽  
Jennifer Kramer ◽  
Gillian Allen
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
African American ◽  
Access To Health Care ◽  
Cultural Beliefs ◽  
Ample Evidence ◽  
Care Services ◽  
Palliative Care Services ◽  
African American Communities ◽  
Hospice And Palliative Care

While there is ample evidence to support the need for hospice and palliative care services for African Americans, only 8% of patients who utilize those services are from African-American communities. The underutilization of end-of-life and palliative care can be attributed to several barriers to service access including incompatibility between hospice philosophy and African-American religious, spiritual, and cultural beliefs; health care disparities; distrust of the medical establishment; physician influence; financial disincentives, and hospice admission criteria. Suggestions for dismantling barriers to care access include developing culturally competent professionals in the health and human services, expanding the philosophy of hospice to include spiritual advisors from client communities, and funding national initiatives to promote improved access to health care at all stages in the life cycle of members of all underserved communities.

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