While the idea of palliative care is increasingly embraced in medical school and residency education, the nuance of cultural diversity in patient and family considerations about death and dying is still not well understood. Additionally, a practitioner’s own beliefs about death and dying can impact the conversation and potentially influence the direction of care. The session Cultural Sensitivity in Palliative Care: Integrating Belief Into Medicine on Sunday at 3:30 pm in room 290 of the convention center aims to give providers a tool set for interfacing with different cultures in the discussion of death and dying, while at the same time encourage them to identify their own beliefs and how those can influence practice. Hunter Groninger, MD, director of the section of Palliative Care at MedStar Washington Hospital Center, answered these questions about the session for the Daily News, with help from chair Danielle McCamey, ACNP, FCCP.
What is the impetus for the session and what are the key takeaways/messages?
→ Dr. Groninger: It is often said that people die the way they lived. While that statement can be interpreted many ways, the end of one’s life, and the conditions and experiences around it, often mirror who that person has come to be over a lifetime. If we are caring for the whole person, we owe it to them to learn about that whole person.
→ Dr. McCamey: We will highlight how we are moving our focus to provide more patient-centered care, which has expanded ways to connect with patients beyond diagnosis and also including their families. We realized there are some gaps from what we learned in school, how our own biases and experiences impact the care we provide, and how it’s really important to understand and have some level of awareness so our patients and families trust us to trust and respect them in regards to culture and diversity.
What are the different tools you will be introducing to help practitioners interface with different cultures in the discussion of death and dying?
→ Dr. Groninger: One simple but critical tool is how we assess and understand individual cultural preferences. For example, a closed ended “yes/no” question leaves little room to learn about spiritual and/or religious preferences that can create deep meaning for the patient. Instead, a more open-ended approach invites significantly more space for people of different beliefs to share what is important to them.
→ Dr. McCamey: Words matter and by really some basic skills on how to frame them when in conversations, we hope we will empower providers to engage in these conversations. In addition, we hope to have open discussions for everyone to share their experiences and techniques that have helped them connect or make space for integrating more cultural awareness in their clinical practice.
How will the session help attendees identify their own beliefs? How do those influence practice?
→ Dr. Groninger: Awareness of oneself is critical to cultural awareness. We all have biases that we bring to work every day. Often, a helpful practice is to take a moment before entering a patient’s room to take note of what is happening inside of you emotionally.
→ Dr. McCamey: We will share simple techniques to encourage this level of awareness to set aside ourselves to make space to receive our patients and families where they are.
What should a clinician do if the family is combative? How do you change the tone?
→ Dr. McCamey:That depends on what feels “combative.” People respond to the physical, emotional, and spiritual stress of dying in every way possible. One must feel physically safe to engage with patients and families. But much more common in this setting is an emotional stress reaction that can present itself as “combativeness”—think of the patient “in denial” or angry. One helpful way to approach these cases is first to validate the emotion, then to think through how that anger or combativeness might actually be an expression of fear or anxiety.