While patient-physician discussions about end-of-life (EOL) care are notoriously difficult, barriers to effective planning is that much harder for patients with diverse ethnicities, according to research from Stanford University School of Medicine published in PLOS ONE.
Study participants were 1,040 multi-specialty physicians caring for seriously ill patients in the Stanford Hospital and Clinics and the VA Palo Alto in California. Almost all--99.99 percent--reported some barriers in conducting effective EOL discussions. Among them, 86 percent said conducting these conversations with patients of a different ethnicity was "a great deal" or "quite a bit" challenging.
The barriers identified by lead author VJ Periyakoil, M.D., clinical associate professor of medicine at Stanford University School of Medicine in California, and colleagues included the following:
- Language and medical interpretation difficulties
- Patient-family religious/spiritual beliefs about death and dying
- Doctors' ignorance of patients' cultural beliefs, values and practices
- Patient/family's cultural differences in truth-handling and decision-making
- Patients' limited health literacy
- Patients' mistrust of doctors and the healthcare system
Although becoming a more culturally competent practice in general may help address the first five EOL-related barriers, the sixth calls on healthcare providers to change patients' understanding on a deeper level. Although studies indicate that Americans consider doctors to be among the most trusted professionals, patients from some ethnic backgrounds may be leery of race-based disparities, the authors noted.
Patients' families may also believe that high-intensity interventions are being withheld or withdrawn from the seriously ill patient because of racism, they continued. "Thus, any notions of withholding high-intensity medical interventions and instituting hospice care may be misinterpreted as deliberate provision of sub-standard care, leading the families to be deeply suspicious of EOL discussions."
To learn more:
- see the study