Review of the Literature on Cultural Competence and End-of-Life Treatment Decisions: The Role of the Hospitalist
Mitchell, Bruce L
Mitchell, Leauna C
Journal of the National Medical Association 2009 Sep; 101(9): 920-6
OBJECTIVE: To determine whether any associations exist between cultural (racial/ethnic, spiritual/religious) competence and end-of-life treatment decisions in hospitalized patients and the potential impact of those associations on hospitalists' provision of care. DATA SOURCES AND METHODS: MEDLINE, PubMed, Embase, Psychlnfo, and CINAHL databases were searched using the following search terms: cultural competence, race, ethnicity, minority, African American, Hispanic, end of life, palliative care, advanced care planning, inpatient, religion, spirituality, faith, hospitalist, and hospice. We identified studies in which spirituality/religion or race/ethnicity was used as a variable to study their potential impact on end-of-life treatment decisions in hospitalized patients. RESULTS: In only 13 studies was spirituality/religion or race/ ethnicity used to study its effect on end-of-life decisions in hospitalized patients. African American patients tended to prefer the use of life-sustaining treatments at the end of life, and race/ethnicity did not appear to affect decisions to withhold or withdraw certain types of life-sustaining technology. Specific spiritual needs were identified both within and outside organized religions when members of those religions were hospitalized at the end of life. CONCLUSIONS: End-of-life care may present unique challenges and opportunities in culturally discordant hospitalist-patient relationships. Culturally competent health care in an increasingly diverse population requires awareness of the importance of culture, particularly spirituality/religion and race/ethnicity, in the care of hospitalized patients at the end of life.
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