Cultural and financial barriers to end-of-life discussions

By Aine Cryts

High-quality care at the end of life is not easy to access, according to a new study.

Lack of financial resources, poor communication with healthcare providers, cultural differences and family conflicts are the customary barriers to delivering the type of end-of-life care that patients need, according to a study of 300 white, Asian and African American seniors that was published in the Journal of Palliative Medicine.

Indeed, about 60 percent of study participants said financial challenges and inadequate health insurance made access to end-of-life care difficult. Seniors typically only have access to short-term nursing home care because of their Medicare coverage. Access to hospice care is also limited to patients whose doctors certify they have only six months to live and agree to forgo treatment to cure their terminal illness, according to Kaiser Health News.

Researchers found that doctors also don't have time to discuss end-of-life issues with patients. Study participants said physician were just too busy to have these conversations and demonstrated a reluctance to listen to their questions and concerns about decision-making at the end of their lives. Another challenge for seniors is physicians often provided vague responses to their questions, which made it more difficult to understand their options and make informed decisions, according to the researchers.

Language and medical interpretation difficulties, patients' limited health literacy, and mistrust of doctors and the healthcare system can also make end-of-life conversations more challenging.

In order to encourage end-of-life conversations, the researchers suggest that doctors receive more training on patients' cultural and spiritual needs. End-of-life conversations are intensely personal. Therefore, doctors must receive training on empathy and cultural awareness to encourage patients to speak more freely about their end-of-life care wishes.

"If we come in with true curiosity, respect and openness, we can learn a lot about how to take care of someone in a sensitive way," Steven Pantilat, M.D., a University of California, San Francisco professor of medicine and director of UCSF's palliative care program, who was not involved in the study, told KHN. "We need to ask: "What do I need to know about your culture and your family to take good care of you?"

Doctors will have new incentives to encourage these discussions. Starting January 1, 2016, Medicare will pay for a total of 60 minutes of advance care planning with patients in both inpatient and outpatient settings.

To learn more:
- see the study
- read the KHN article