Culturally sensitive palliative care in humanitarian action: Lessons from a critical interpretive synthesis of culture in palliative care literature

Abstract

Objective There is growing recognition of the importance of increasing preparedness for and the provision of palliative care in humanitarian crises. The primary objective of this review is to interpret the existing literature on culture and palliative care to query the recommendation that humanitarian healthcare providers, teams, and organizations integrate palliative care into their practice in ways that are attentive to and respectful of cultural differences. Methods A critical interpretive synthesis was applied to a systematic literature review guided by the PRISMA framework. Analysis was based on directed data extraction and was team based, to ensure rigor and consistency. Results In total, 112 articles covering 51 countries and 9 major worldviews met inclusion criteria. This literature describes culture as it influences perspectives on death and dying, expectations of palliative care, and challenges to providing culturally sensitive care. A key pattern highlighted in articles with respect to the culture and palliative care literature is that culture is invoked in this literature as a sort of catch-all for non-white, non-Christian, indigenous practices, and preferences for palliative care. It is important that humanitarian healthcare providers and organizations aiming to enact their commitment of respect for all persons through attention to potential culturally specific approaches to pain management, suffering, and dying in specific crisis settings do so without reproducing Othering and reductionistic understandings of what culturally sensitive care in humanitarian crises settings involves. Significance of results This paper clarifies and unpacks the diverse influences of culture in palliative care with the goal of supporting the preparedness and capacity of humanitarian healthcare providers to provide palliative care. In doing so, it aids in thinking through what constitutes culturally sensitive practice when it comes to palliative care needs in humanitarian crises. Providing such care is particularly challenging but also tremendously important given that healthcare providers from diverse cultures are brought together under high stress conditions.

The impact of the COVID-19 pandemic on palliative care practice: A survey of clinical oncologists

“…Furthermore, when it comes to the current status of the palliative care system in China, most specialists deemed that it remained underdeveloped. They also agreed that many other factors besides COVID-19 were associated with it, presumably on account of the unbalanced medical resources, conflicts of traditional values, and reluctance from patients (33)(34)(35). Thus, the development of palliative care still needs further efforts, not only in the current context of the pandemic but in the future.…”

“…Oncologists are known to provide supportive care with professional decisions, psychological counseling, and complex symptom management, especially for patients with advanced cancer ( 39 ). Providing such care is particularly challenging but also tremendously meaningful, given that humanitarian palliative caregivers with sufficient preparedness and capacity to cope with the current high-stress conditions of the COVID-19 pandemic may further improve the quality of life and optimize overall survival for cancer patients ( 35 ). Moreover, our study also highlighted that the issues and needs of palliative care practitioners should raise public concern and be further addressed.…”

Aid when ‘there is nothing left to offer’: Experiences of palliative care and palliative care needs in humanitarian crises

“…Finally, reframing non-curative treatment as an enactment of humanitarian principles related to alleviating suffering and promoting dignity can reassure distressed responders [29]. Improving comfort by improvising ways to elevate patients into a reclined position using crates, holding hands, and other simple acts of care and compassion make a real difference, and help providers feel more empowered to provide good care.…”

Palliative and End-of-Life Care Access for Immigrants Living in High-income Countries: A Scoping Review

“…To access care by immigrants with CaLD background, there needs to be an understanding of, and respect for their cultural needs by the palliative and EOL care service providers (Green et al, 2019). Historically, discrimination, racial profiling, and marginalization are realities that impact on seeking health care services (Schuster-Wallace et al, 2022). The solution lies in addressing the identified vices so that immigrant communities can develop trust in the health care system, something that has been eroded.…”

“…Cultural sensitivity by health care providers toward CaLD patients, is of paramount importance in encouraging them to utilize the services especially EOL care. Sensitivity requires recognition that not all cultures are the same, or even similar and that an effort should be made in identifying the different cultures of patients to gain confidence and trust (Schuster-Wallace et al, 2022). Culture specific engagement in palliative care is the key to accessibility by immigrant communities (Quinn & Hickey, 2008).…”