Review of the Literature on Cultural Competence and End-of-Life Treatment Decisions: The Role of the Hospitalist by ProQuest


More Info
									o      r     i    g      i    n      a      l          c      o      m      m    u   n     i   c    a    t    i   o    n

Review of the Literature on Cultural
Competence and End-of-Life Treatment
Decisions: The Role of the Hospitalist
Bruce L. Mitchell, MD; Leauna C. Mitchell, RN


  Objective: To determine whether any associations exist
  between cultural (racial/ethnic, spiritual/religious) compe-                        n Western medicine, a fundamental unit of health
  tence and end-of-life treatment decisions in hospitalized                           care is the patient-physician relationship. In the
  patients and the potential impact of those associations on                          United States, the new paradigm of inpatient care, in
  hospitalists’ provision of care.                                               which hospitalists oversee patients’ care and treatment,
                                                                                 has been accepted by nearly all leading hospitals and is
  Data Sources and Methods: MEDLINE, PubMed, Embase,
                                                                                 in place or being considered by most other hospitals. In
  PsychInfo, and CINAHL databases were searched using the
                                                                                 2005, survey data from the American Hospital Associa-
  following search terms: cultural competence, race, ethnic-
                                                                                 tion noted that 40% of the 4936 community hospitals in
  ity, minority, African American, Hispanic, end of life, pallia-
                                                                                 the United States have hospitalist programs, and the pro-
  tive care, advanced care planning, inpatient, religion, spiri-
                                                                                 portion was 70% for hospitals with 200 or more beds.1
  tuality, faith, hospitalist, and hospice. We identified studies
                                                                                     This system of care typically does not give the patient
  in which spirituality/religion or race/ethnicity was used as a
                                                                                 (or the patient’s family) a choice of physicians or the
  variable to study their potential impact on end-of-life treat-
                                                                                 physician the opportunity to consult with the patient
  ment decisions in hospitalized patients.
                                                                                 before hospital admission. As most Americans die in
  Results: In only 13 studies was spirituality/religion or race/                 acute care hospitals,2,3 hospitalists are asked routinely to
  ethnicity used to study its effect on end-of-life decisions in                 provide end-of-life care for patients with whom they
  hospitalized patients. African American patients tended to                     have not had previous interaction and who typically are
  prefer the use of life-sustaining treatments at the end of life,               not given a choice of inpatient providers. Thus, the par-
  and race/ethnicity did not appear to affect decisions to                       ties are brought together at a most stressful time without
  withhold or withdraw certain types of life-sustaining technol-                 the benefit of prior acquaintance or interaction. The
  ogy. Specific spiritual needs were identified both within and                  increasing diversity and rapidly changing demographics
  outside organized religions when members of those religions                    of the US population increase the likelihood that the
  were hospitalized at the end of life.                                          patient and physician will come from different sociocul-
  Conclusions: End-of-life care may present unique chal-                         tural backgrounds.
  lenges and opportunities in culturally discordant hospitalist-                     Culture is not entirely based on a person’s race/ethnic-
  patient relationships. Culturally competent health care in an                  ity and is determined by such influences as spirituality/
  increasingly diverse population requires awareness of the                      religion, economic status, level of education and accul-
  importance of culture, particularly spirituality/religion and                  turation, age, gender, sexual orientation, and country of
  race/ethnicity, in the care of hospitalized patients at the                    origin and immigration status. Culture plays an impor-
  end of life.                                                                   tant role in how individuals (including physicians) see
                                                                                 themselves and others with whom they interact. Individ-
  Keywords: race/ethnicity n hospital/office administration                      uals’ cultural identity fundamentally influences how they
  n spirituality                                                                 understand illness and dying and the decisions they make
                                                                                 at the end of life. Sociocultural differences between phy-
  J Natl Med Assoc. 2009;101:920-926
To top