Culturally appropriate end-of-life care

The provision of culturally appropriate end-of-life care involves clinicians eliciting and complying with the older person’s preferences and values about disclosure and decision-making processes.

The power imbalance in clinician-client interactions may make it difficult for some CALD people to request their cultural/religious care preferences (Hofstede, 2002). Clinicians need to offer autonomy to clients while respecting and acknowledging different cultural norms such as preferences for non-maleficence, non-disclosure and rights to independent decision-making.

CALD older people may prefer family-based decision making processes and may refuse to make decisions in regard to their medical investigations or diagnostic procedures. In these cases clients must be provided with clear and voluntary choices. Some cultures prefer to communicate information about serious illness and death subtly instead of explicitly, by using facial expressions, voice tone and other nonverbal cues. However, it is important not to stereotype or make assumptions about a CALD person’s cultural beliefs, preferences and values, but to always ask.

Assessing the clients’ ability to speak and understand English or their ability to read written information in English or any other language is essential to the provision of quality health care. Ensuring that the older person has a professional interpreter (if needed) is not only important for clear communication but also to ensure that decisions made by and for them are legal and without any undue influence. It is highly inappropriate to use a family member to interpret, especially when giving bad news to an older person.

Here is a CALD End-of-Life Care Assessment Tool with suggested questions and strategies for health practitioners to consider when assessing CALD clients and their family.