How Do Hospice Providers Address Diversity, Equality and Inclusion?

While hospices provide similar standards of care for patients, most providers offer specialized care or programs to better serve the needs of diverse populations. Military service, sexual orientation, ethnicity, gender, race, religion, or cultural beliefs can influence how care is given, as well as how it is perceived by the patient and their family. Thus the need for hospice providers to recognize and remain sensitive to the needs of diverse patient populations is very real. This is especially true today, when the U.S. population is becoming more ethnically and racially diverse; more people identify as LBGTQ and non-binary, and people with both physical and developmental disabilities are living longer lives. 

Specifically, cultural, racial, or ethnic beliefs can influence patient care preferences or treatment goals in many ways. The American Psychological Association offers the following examples:

• Preference for less or more aggressive treatments
• How pain should be managed (or not)
• Whether family should be involved in primary decision making
• Beliefs about life saving measures (resuscitation, feeding tube, intubation)
• Attitudes toward advance planning
• Views on death and dying
• Differing opinions on what constitutes quality of life

What’s more, members of certain ethnic minorities, particularly Blacks and Latino individuals, often have a deeply ingrained and well-founded distrust of the medical system, which can negatively impact their ability to accept hospice or palliative care. 

Ensuring Culturally Sensitive Care

Throughout the U.S. healthcare system, implicit and explicit bias and discrimination has historically had a negative effect on the healthcare outcomes of racial, ethnic and cultural minorities, including at the end of life. And while efforts have been made to address these inequities, culturally sensitive educational programs for doctors, nurses and ancillary care providers are not widespread. Further, racial minorities remain underrepresented in the healthcare workforce today. 

Still, some hospice providers are making efforts to be more inclusive and incorporating training for their employees in how to provide care within a cultural framework while remaining aware of the fact that every patient is an individual with deeply held values, goals, preferences and needs. As noted in the publication Diversity and Discrimination in Healthcare by Brandon M. Togioka et al., focusing on “typical” characteristics of minority groups can reinforce the incorrect assumption that the impact of culture on a person’s beliefs and values is “fixed.” Instead, the authors suggest that healthcare providers realize that a patient’s views are influenced by culture, race, ethnicity, gender identity and individual life experiences but are determined by many other factors that can only be elicited by getting to know the”person behind the patient” and meeting that person’s needs. 

Sources

“1.2 million LGBTQ adults in the US identify as nonbinary”. UCLA School of Law: Williams Institute. https://williamsinstitute.law.ucla.edu/press/lgbtq-nonbinary-press-release/ 

“Culturally Diverse Communities and Palliative and End-of-Life Care”. American Psychological Association. https://www.apa.org/pi/aging/programs/eol/end-of-life-diversity 

“Understanding and Ameliorating Medical Mistrust Among Black Americans”. The Commonwealth Fund. https://www.commonwealthfund.org/publications/newsletter-article/2021/jan/medical-mistrust-among-black-americans 

“Diversity and Discrimination in Health Care”. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK568721/