IMPROVING EQUITY IN HOSPICE ACCESS BY REDUCING CULTURAL BARRIERS IN HOSPICE SERVICES AND HOSPICE DISCUSSIONS FOR NONWHITE US GROUPS

Abstract

Urban Bioethics

M.A.

Though there is ample evidence in existing literature demonstrating racial inequity in end-of-life care, there is minimal examination of how the culturally mainstream values of hospice contribute to inequity and reduced access for nonwhite populations. This paper reviews participatory action research, interviews and chart reviews of nonwhite populations including African Americans, Latinx, Asians and Native Americans to determine what end-of-life values these groups report and how they differ from the values of hospice and western biomedicine. All of these groups reported unmet cultural needs with respect to hospice access ranging from differing communication style preferences to different religious beliefs to different ideas about what they dying process should look like. Contributing to these barriers was practitioner ignorance about cultural variance in end-of-life preferences, demonstrated by studies of physicians to identify barriers to effectively providing end-of-life care. To help foster better knowledge and understanding between practitioners and nonwhite patients whose cultural needs are not being met, I have created a value-assessment tool to add to the standard structure of end-of-life conversations. Using this tool with patients in end-of-life conversations could improve physician confidence in understanding the needs of patients and provide patients an opportunity to freely communicate their needs and therefore increase access to the hospice services that can meet those needs.

Temple University--Theses