Cultural Diversity in End of Life Care by Upinder Sing (MD, CMD, AGSF, FACP), as presented within the GWEP 2018 January Conference

1. Cultural Diversity
in
End of Life care
Upinder Singh, MD, CMD, AGSF, FACP
VP Medical Affairs, Kindred Healthcare
CMO Silver State ACO

2. Better Understanding of Life
• Appreciate and Acknowledge
– Dying
– Death
– Bereavement

3. ‘Every life is different from any that has gone
before it, and so is every death.
The uniqueness of each of us extends even to
the way we die’
Nuland, 1994

4. Ethnocentrism
• Belief that one's own culture is superior to all others.
• This belief is common to all cultural groups, all groups regard their
own culture as not only the best but also the correct, moral and
only way of life.
• This belief is pervasive, often unconscious and is imposed on
every aspect of day-to-day interaction and practices including
health care.

5. Ethnocentrism
• It is this attitude which creates problems
between health system and clients of diverse
cultural groups.

6. We need to understand...
• how cultural groups understands life processes
• how cultural groups define health and illness
• what cultural groups do to maintain wellness
• what cultural groups believe to be the causes of
illness
• how healers cure and care for members of cultural
groups
• how the cultural background of the health care
provider influences the way in which care is
delivered.

7. • Recognizing cultural diversity, integrating
cultural knowledge, and acting, when
possible, in a culturally appropriate manner
enables us to be more effective in initiating
assessments and serving as client advocates.

8. Focus on the individual & on planning for
death presupposes
that the individual
 is the primary decision-maker
 has an interest in being in charge
 has equal financial access to the different options offered
 has the power and sense of entitlement to make whatever choice is
desired
 values discussing and planning for death
 has a spiritual orientation that does not emphasize divine
interventions, and allows for choice in time and manner of death
(Koenig, 1997).

9. “Ethnic Mnemonic”
E: Explanation
T: Treatment
H: Healers
N: Negotiation
I: Intervention
C: Collaboration and Communication
Developed by: Steven J. Levin, MD; Robert C. Like, MD; Jan E. Gottlieb, MD.
Department of Family Medicine, UMDNJ-Robert Wood Johnson Medical
School.

10. The LEARN Model
Berlin and Fowkes
Listen to the patient’s perception of the problem
Explain your perception of the problem
Acknowledge and discuss differences/similarities
Recommend treatment
Negotiate treatment

11. Barriers to effective therapeutic
relationship
• inexperience
• discomfort
• inability to honestly examine own prejudices

12. Remember...
• Generalizations about any religion/culture are
problematic
• Continuously evolve to meet changing needs
• Wide variations occur within same group

13. Best way...
• When in doubt, ask