Cultural considerations in endoflife care Communication

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Cultural considerations in end-of-life care
Communication

• Marina ?.Bialik
• Palliative Care Initiative, Inc.

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Some difficult subjects

• Advance Directive
• Health-care Proxy
• Living Wills
• Decision Making
• Hospice/Palliative Care
• Pain Management
• Bereavement Care

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Conversations about the end of life (contd)

• Advance Directives
• No knowledge about them (19 - 95)
• I know about it because
• In hospital I was asked to sign it. It is a
  document about my prospective wishes regarding
  health care in critical situations.
• Also I was asked to sign it for my mother in
  critical situation. I told her about every aspect
  of this choice. I was glad she made all the
  decisions by herself.
• I only had conversation about organs donation
  when I took my driving license.

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Do you know anyone who has had hospice care?

• What was that experience like?
• It was like a miracle. Everybody was patient,
  considerate, competent, willing to help.
• Mother died peacefully with dignity.
• Our friend had his wife as a caregiver. She
  thought that she did everything perfectly. But
  only when people from a hospice joined her his
  suffering really decreased.

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Barriers to Communication

• Fear of mortality
• Lack of experience
• Avoidance of emotion
• Insensitivity
• Sense of guilt

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Barriers to Communication (cont.)

• Fear of not knowing
• Disagreement with decisions
• Lack of understanding culture or goals
• Personal grief issues
• Ethical concerns

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Communication

• Terminal illness is a family experience
• Imparting information so individuals may make
  informed decisions
• Requires interdisciplinary collaboration
• Kimberlin et al., 2004

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Myths of Communication

• Communication is deliberate
• Words mean the same to sender/receiver
• Verbal communication is primary
• Communication is one way
• Cant give too much information

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Support system
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Death of a Parent.Remember the Children

• Be aware of the developmental stage of the child
• Communicate openly and honestly
• Children need opportunities to ask questions
• Questions should be answered in terms that they
  can comprehend
• Davies, B., 2006

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Thank you Marina A. Bialik PhD
Palliative Care Initiative, Inc. http//ppci.Choo
singHope.info