Compared to Whites, racial/ethnic minorities are less likely to enroll in hospice and if they enroll, more likely to experience poor quality care. Building cultural competence (CC) among hospice staff is a strategy that may reduce disparities.
Objective:
To describe the state of CC training across hospices.
Design:
National survey of hospices’ practices to promote CC.
Results:
A total of 197 hospices participated; most were not-for-profit (80%) with an average daily census less than 100 (47%); 73% offered staff cultural competence training (CCT). There were no differences in characteristics of hospices who offered CCT and those that did not. Of hospices offering CCT, 61% held it annually. Most trainings were 1 hour (60%); content was delivered via web (58%) and/or lecture (58%). While over 90% of staff (i.e., nurses, social workers, chaplains) completed CCT, a smaller proportion of medical directors (64%), senior leaders (71%) and board members (26%) did so. Most common topics were: cross-cultural communication, death/illness beliefs, spirituality’s role, and healthcare disparities. The majority focused on African-Americans (83%), Hispanics (76%), and Asians (62%)—the most common U.S. minority groups. Almost 30% reported no effectiveness assessment of CCT, while 51% reported a quiz at the end of training. Most hospices offered some CCT.
Conclusions:
CCT has been shown to improve healthcare providers’ knowledge and skills in caring for diverse patients and it is associated with increased patient satisfaction. Future research should evaluate effectiveness of CCT in improving the ability of hospices to deliver high quality end-of-life care to diverse groups of older adults.
KelleyASDebPDuQAldridge CarlsonMDMorrisonRS. Hospice enrollment saves money for Medicare and improves care quality across a number of different lengths-of-stay. Health Affairs. 2013;32(3):552–561.
2.
TenoJM. Family perspectives on end-of-life care at the last place of care. JAMA. 2004;291(1):88.
3.
BradleyEHPrigersonHCarlsonMDCherlinEJohnson-HurzelerRKaslSV. Depression among surviving caregivers: does length of hospice enrollment matter?Am J Psychiatr. 2004;161(12):2257–2262.
RhodesRLTenoJMConnorSR. African American bereaved family members’ perceptions of the quality of hospice care: lessened disparities, but opportunities to improve remain. J Pain Symptom Manage. 2007;34(5):472–479.
6.
RhodesRLXuanLHalmEA. African American bereaved family members’ perceptions of hospice quality: do hospices with high proportions of African Americans do better?J Palliat Med. 2012;15(10):1137–1141.
7.
TenoJMPlotzkeMChristianTGozaloP. Examining variation in hospice visits by professional staff in the last 2 days of life. JAMA Intern Med. 2016;176(3):364–370.
8.
RizzutoJAldridgeMD. Racial disparities in hospice outcomes: a race or hospice-level effect?J Am Ger Soc. 2018;66(2):407–413.
GovereLGovereEM. How effective is cultural competence training of healthcare providers on improving patient satisfaction of minority groups? A systematic review of literature. Worldviews Evid Based Nurs. 2016;13(6):402–410.
11.
JongenCMcCalmanJBainbridgeR. Health workforce cultural competency interventions: a systematic scoping review. BMC Health Serv Res. 2018;18(1):232.
12.
AbuDaggaAWeech-MaldonadoRTianF. Organizational characteristics associated with the provision of cultural competency training in home and hospice care agencies. Health Care Manage Rev. 2018;43(4):328–337.
13.
BoucherNA. Direct engagement with communities and interprofessional learning to factor culture into end-of-life health care delivery. Am J Public Health. 2016;106(6):996–1001.
14.
BeachMCPriceEGGaryTL, et al.Cultural competence: a systematic review of health care provider educational interventions. Med Care. 2005;43(4):356–373.
15.
JohnsonKS. Racial and ethnic disparities in palliative care. J Palliat Med. 2013;16(11):1329–1334.
16.
JohnsonKSElbert-AvilaKITulskyJA. The influence of spiritual beliefs and practices on the treatment preferences of African Americans: a review of the literature. J Am Geriatr Soc. 2005;53(4):711–719.
17.
JohnsonKSKuchibhatlaMTulskyJA. Racial differences in location before hospice enrollment and association with hospice length of stay. J Ame Ger Soc. 2011;59(4):732–737.
18.
FerrellBRTwaddleMLMelnickAMeierDE. National Consensus Project Clinical Practice Guidelines for Quality Palliative Care Guidelines, 4th edition. J Palliat Med. 2018;21(12):1684–1689.
SchimSMDoorenbosAZBorseNN. Enhancing cultural competence among hospice staff. Am J Hosp Palliat Care. 2006;23(5):404–411.
22.
JohnsonKSKuchibhatlaMTulskyJA. What explains racial differences in the use of advance directives and attitudes toward hospice care?: racial differences in beliefs about end-of-life care. J Ame Ger Soc. 2008;56(10):1953–1958.
23.
Office of Minority Health, US Department of Health and Human Services. Improving Cultural Competency for Behavioral Health Professionals. n.d. Accessed July 21, 2020. https://thinkculturalhealth.hhs.gov/ICCfBHP
24.
FerrellBMalloyPViraniR. The end of life nursing education nursing consortium project. Ann Palliat Med. 2015;4(2):61–69.
25.
MatzoMLShermanDWMazanecPBarberMAViraniRMcLaughlinMM. Teaching cultural considerations at the end of life: end of life nursing education consortium program recommendations. J Contin Educ Nurs. 2002;33(6):270–278.
26.
GrandpierreVMilloyVSikoraLFitzpatrickEThomasRPotterB. Barriers and facilitators to cultural competence in rehabilitation services: a scoping review. BMC Health Serv Res. 2018;18(1):23.
27.
ReeseDJBeckwithSK. Organizational barriers to cultural competence in hospice. Am J Hosp Pallia Care. 2015;32(7):685–694.
28.
ZhengNTMukamelDBCaprioTCaiSTemkin-GreenerH. Racial disparities in in-hospital death and hospice use among nursing home residents at the end of life. Med Care. 2011;49(11):992–998.
29.
US Department of Health and Human Services. National Standards for Culturally and Linguistically Appropriate Services in Health and health Care: A Blueprint for Advancing and Sustaining CLAS Policy and Practice. Office of Minority Health; 2013.
30.
PeriyakoilVSNeriEKraemerH. No easy talk: a mixed methods study of doctor reported barriers to conducting effective end-of-life conversations with diverse patients. PLoS One. 2015;10(4):e0122321.
31.
WelchLCTenoJMMorV. End-of-life care in black and white: race matters for medical care of dying patients and their families. J Am Geriatr Soc. 2005;53(7):1145–1153.
32.
MackJWPaulkMEViswanathKPrigersonHG. Racial disparities in the outcomes of communication on medical care received near death. Arch Intern Med. 2010;170(17):1533–1540.
33.
IngersollLTAlexanderSCPriestJ, et al.Racial/ethnic differences in prognosis communication during initial inpatient palliative care consultations among people with advanced cancer. Patient Educ Coun. 2019;102(6):1098–1103.
34.
HorvatLHoreyDRomiosPKis RigoJ. Cultural competence education for health professionals. In: The Cochrane Collaboration, ed. Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd; 2014.
35.
LieDALee-ReyEGomezABereknyeiSBraddockCH III. Does cultural competency training of health professionals improve patient outcomes? A systematic review and proposed algorithm for future research. J Gen Intern Med. 2011;26(3):317–325.
36.
RenzahoAMRomiosPCrockCSonderlundAL. The effectiveness of cultural competence programs in ethnic minority patient-centered health care—a systematic review of the literature. Int J Qual Health Care. 2013;25(3):261–269.
