MULTICULTURAL PERSPECTIVES ON END- OF-LIFE DECISIONS AND PALLIATIVE CARE

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1 MULTICULTURAL PERSPECTIVES ON END- OF-LIFE DECISIONS AND PALLIATIVE CARE Association for Multicultural Affairs in Transplantation September 18 th, 2013 Marwa Kilani, M.D. Medical Director, Palliative Care Providence Holy Cross Medical Center

2 OBJECTIVES Examine the impact of multicultural perspectives on end-of-life decision-making including donation approach outcomes Explore methods for appropriately assessing the unique needs of each patient and family Discuss the role of Palliative Care within the Critical Care Setting and how it parallels the OneLegacy Family Care process

3 DISCLOSURE Nothing to Disclose.

4 PALLIATIVE CARE DEFINED The goal of palliative care is to prevent and relieve suffering and to support the best possible quality of life for patients and their families, regardless of the stage of the disease or the need for other therapies Palliative care affirms life by supporting the patient and family s goals for the future, including their hopes for cure or life-prolongation, as well as their hopes for peace and dignity throughout the course of illness, the dying process and death. Excerpted from Clinical Practice Guidelines for Quality Palliative Care, AAHPM

5 PALLIATIVE CARE DEFINED

6 PALLIATIVE CARE DEFINED Provided by a Team: MD, RN, MSW, Chaplain Experts at Communication Specialized Pain and Symptom Management Guidance with Options for Medical Treatment Help Navigate the Complex Healthcare System Provide Spiritual and Emotional Support

7 PALLIATIVE CARE

8 MULTICULTURAL PERSPECTIVES We re on our way to becoming the first country in history that is literally made up of every part of the world. Kenneth Prewitt, former Director, U.S. Census Bureau

9 MULTICULTURAL PERSPECTIVES melting pot: implies that immigrants change to fit the society of their new home salad bowl: implies that immigrants retain their cultural identity in their new home kaleidoscope: implies that both the immigrants and society adapt and change Cultural Diversity in the United States How would you describe America s diverse cultural landscape? Nancee Hunter, National Geographic

10 MULTICULTURAL PERSPECTIVES American Core Values Autonomy Individual Rights to Make Life Choices Patient Self Determination Act 1990 MAY be in Conflict with United States Diverse Groups Campinha-Bacote, 2011; Doorenbos et al., 2010; Eues, 2007; Giger, Davidhizar, & Fordham, 2006; Huff & Kline, 2007b; Searight & Gafford, 2005a

11 MULTICULTURAL PERSPECTIVES C U L T U R E Communication Unique Cultural Values Locus of Decision Making Translators Understanding the Patient Ritualized Practices and Restrictions Environment at Home Lum H and Arnold R. Asking About Cultural Beliefs in Palliative Care. Fast Facts and Concepts. June 2009; 216

12 MULTICULTURAL PERSPECTIVES Kagawa-Singer & Blackhall s ABCD Cultural Assessment Model (2001) Attitudes of parents and families Beliefs Context Decision-making style Environment

13 MULTICULTURAL PERSPECTIVES Get to Understand the Family s Background Who is Considered the Spokesperson? What are Their Cultural or Religious Views on Illness and End-of-Life? What Language is easier in Communication? What Terms or Words have Different Connotations? How is Bad News Discussed?

14 MULTICULTURAL PERSPECTIVES The Main Rule is There is no Rule! Treat each Patient as an Individual. Never AssUMe

15 PALLIATIVE CARE FOCUS Family Conferencing Interdisciplinary Approach Open Communication Define family s perceptions Review treatment goals, prognosis Understand Who Patient is Understand What is Important to Patient Provide Support Emotional, Psychosocial, Spiritual & Cultural Follow-Up and Documentation

16 ONELEGACY FAMILY CARE FOCUS Family Conferencing Interdisciplinary Approach Support and normalize family s grief Address and affirm religious/cultural views Identify and resolve any family issues/concerns Help family transition from loved one being present to past Provide ongoing support

17 PALLIATIVE CARE AND DONATION Palliative Care Collaborative Leadership Attending MD Bedside Nurse Palliative Care Team OPO Family Support Services Family Consistent, Clear Communication leads to Understanding & TRUST

18 CONCLUSION Integrating a Palliative Care team may help Bridge an End-of-Life Process in a Culturally sensitive manner Palliative Care s Focus on Comfort, Support and Family Align with Most Cultures Values and Beliefs Consistent and Clear Communication leads to Understanding and Trust

19 THANK YOU!! Marwa Kilani, M.D. Phone: Snail: Rinaldi Street Mission Hills, CA 91346

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