Cultural considerations at end of life in a geriatric inpatient rehabilitation setting

Aim: To explore the impact of cultural factors on the provision of end-of-life care in a geriatric inpatient rehabilitation setting.
Background: Australia’s ageing population is now also one of the most culturally diverse. Individuals from culturally and linguistically diverse backgrounds may have specific care needs at the end of life according to various aspects of their culture.
Design: A mixed method approach using a retrospective audit of existing hospital databases, deceased patients’ medical records, and in-depth interviews with clinicians.
Findings: Patients’ and families’ cultural needs were not always recognised or facilitated in end-of-life care, resulting in missed opportunities to tailor care to the individual’s needs.
Clinicians identified a lack of awareness of cultural factors, and how these may influence end-of-life care needs. Clinicians expressed a desire for education opportunities to improve their understanding of how to provide patient-specific, culturally sensitive end-of-life care.
Conclusion: The findings highlight that dying in geriatric inpatient rehabilitation settings remains problematic, particularly when issues of cultural diversity further compound end-of-life care provision. There is a need for recognition and acceptance of the potential sensitivities associated with cultural diversity and how it may influence patients’ and families’ needs at the end of life. Health service organisations should prioritise and make explicit the importance of early referral and utilisation of existing support services such as professional interpreters, specialist
palliative care and pastoral care personnel in the provision of end-of-life care. Furthermore, health service organisations should consider reviewing end- of-life care policy documents, guidelines and care pathways to ensure there is an emphasis on respecting and honouring cultural
diversity at end of life. If use of a dying care pathway for all dying patients was promoted, or possibly mandated, these issues would likely be addressed.