Underlying provider perceptions of caring for patients was that death is difficult in any language. Care was conceptualised as considering cultural and linguistic backgrounds within individualistic care. Understanding the migration experience and building trust were key elements of this individualised approach. Acknowledgement of the key role played by families in patient care and safety are strategies to minimise barriers and understand the concerns of this patient group.

This study was conducted at a subacute hospital with a specialist palliative care unit and a community palliative care service in a metropolitan region of New South Wales, Australia. Medical records of 100 deceased patients from CALD backgrounds over a 12-month period from 2014 to 2015 were recorded on a data mining tool. The cohort had transitioned to either community or inpatient palliative care services with a life-limiting illness. We used descriptive statistical analyses to identify the patients' end-of-life journeys in the physical, psychological, spiritual, and social palliative care domains. Staff case notes were used to enrich the quantitative data.ResultThe most common symptoms burdening the patients were decreased mobility (82%), pain (76%), and poor appetite (60%). The majority of patients (87%) were diagnosed with cancer. Language was a major barrier to the assessment and management of symptoms. The vast majority of patients were born in Europe and Asia. Twenty-nine percent of the patients preferred to use English. However, among patients who required an interpreter on admission, only 9% used professional interpreters. Family distress around patients' lack of food consumption was prominent, along with provider concern when this led to families "force feeding" patients. Only 5% of files documented patients', and 21% of files documented families', cultural wishes or needs. Care of the body after death was only documented in 20% of files.Significance of resultsThe increasing cohort of older people from CALD backgrounds will have significant implications for the planning and delivery of palliative care services. There is an emerging need to address the physical, psychological, spiritual, and social palliative care domains in the end-of-life journeys of patients from CALD backgrounds to ensure the provision of quality care.

This study aimed to establish whether Pastoral Care (PC) visits were an effective component of a hospitalised patient's overall health experience. Outcomes of PC visits were reported by 369 patients in 7 sites across Australia. The patient reported outcomes of PC visits included: the patients felt they could be honest with themselves, with a sense of peace, a better perspective of their illness, less anxiety and felt more in control. Five factors of the PC visit significantly related to higher patient's overall outcomes: 1) having more Pastoral Care visits (p<0.5 0R 0.778, CI 0.17-1.38); 2) the patient was able to talk about what was on their mind (p<0.01, OR1.48, CI 0.58-2.37); 3) they had something to be hopeful about (p<0.01 OR1.18, CI 0.51-1.85); 4); the visit focused on decisions about the patient's healthcare (p<0.05, OR0.70, CI 0.05-1.35); and 4) a belief in God/Higher Being (p<0.01, OR 1.01, CI 0.43-1.71).