Living and Dying in a Disparate Health Care System: Rationale and Strategies for Cultural Humility in Palliative and Hospice Care Physical Therapy

Barnes, Christopher J.; Mueller, Karen Thudium; Fawcett, Lubayna; Wagner, Barbara

doi:10.1097/01.reo.0000000000000199

Cited by 6 publications

(15 citation statements)

References 48 publications

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“…Evidence has shown that there are existing disparities in diversity, equity and inclusivity within healthcare and society. 88 Recent findings of other studies focused on race and income 89,90 reveal that income and resources may indicate poorer health outcomes, as opposed to race. Viewing mistrust and lack of communication through lens of health disparities, attributed to lower resources and lack of adequate care can diminish notions that all inequality is due to race/ethnicity.…”

Section: Discussionmentioning

confidence: 99%

Preparedness for Serious Illnesses: Impact of Ethnicity, Mistrust, Perceived Discrimination, and Health Communication

Bazargan

Cobb

Assari

et al. 2021

Am J Hosp Palliat Care

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Background: Increasing severity of serious illness requires individuals to prepare and make decisions to mitigate adverse consequences of their illness. In a racial and ethnically diverse sample, the current study examined preparedness for serious illness among adults in California. Methods: This cross-sectional study used data from the Survey of California Adults on Serious Illness and End-of-Life 2019. Participants included 542 non-Hispanic White (52%), non-Hispanic Black (28%), and Hispanic (20%) adults who reported at least one chronic medical condition that they perceived to be a serious illness. Race/ethnicity, socio-demographic factors, health status, discrimination, mistrust, and communication with provider were measured. To perform data analysis, we used logistic regression models. Results: Our findings revealed that 19%, 24%, and 34% of non-Hispanic White, non-Hispanic Blacks, and Hispanic believed they were not prepared if their medical condition gets worse, respectively. Over 60% indicated that their healthcare providers never engaged them in discussions of their feelings of fear, stress, or sadness related to their illnesses. Results of bivariate analyses showed that race/ethnicity was associated with serious illness preparedness. However, multivariate analysis uncovered that serious illness preparedness was only lower in the presence of medical mistrust in healthcare providers, perceived discrimination, less communication with providers, and poorer quality of self-rated health. Conclusion: This study draws attention to the need for healthcare systems and primary care providers to engage in effective discussions and education regarding serious illness preparedness with their patients, which can be beneficial for both individuals and family members and increase quality of care.

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Section: Discussionmentioning

confidence: 99%

Preparedness for Serious Illnesses: Impact of Ethnicity, Mistrust, Perceived Discrimination, and Health Communication

Bazargan

Cobb

Assari

et al. 2021

Am J Hosp Palliat Care

View full text Add to dashboard Cite

show abstract

“…[5][6][7][8][9][10][11]13,14,16,20,27 Educators arguing against cultural competence frameworks maintain that becoming culturally competent is not possible and relying on this framework implies that providers are "checking off" skills in an attempt to learn about culture. [5][6][7][8][9][10][11]13,14,16,20,27 Research suggests that cultural competence frameworks portray culture as static and fail to acknowledge that it is shaped by the patient's interactions with others, their community, institutions, media, technology, and environmental factors. 8 Some scholars contend that curriculum content for teaching and assessing cultural competence is dictated by highly educated, privileged individuals who lack the perspective of the underrepresented minority.…”

Section: Framework For Understanding the Problemmentioning

confidence: 99%

“…10 e major argument against the use of cultural competence frameworks is that they foster static views and fail to adequately recognize individuality. [5][6][7][8][9][10][11]13,14,16,20,27 Students need to appreciate that beliefs and practices of a single culture may not be identical for all people of that culture.…”

Section: Framework For Understanding the Problemmentioning

confidence: 99%

“…• Nonlinear, intersecting concepts 35,37,38 • Defined constructs 16,[35][36][37][38] • Addresses social injustice 16,35,36 • Structure considers multiple perspectives (individual, family, and global factors) 16,35,36 Cultural humility • Addresses power imbalances between patient and provider 5,22 • Learn from the patient 5,8 • Active listening 8…”

Section: Cultural Competencementioning

confidence: 99%

“…• Lifelong process 5,20 • Emphasizes patient-provider collaboration 5,8,34 educational approaches exists. is variation is also discussed in the literature which is informed by other health care professions regarding the selection of cultural competence and cultural humility frameworks, and instructional methods.…”

Section: Shared Characteristicsmentioning

confidence: 99%

See 2 more Smart Citations

Cultural Competence and Cultural Humility: A Dialogue on Adopting a Multimodel Approach in Physical Therapist Education

Bangs

Hayward

Donlan

2022

JOPTE

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Background and Purpose. Integrating the concepts of cultural humility and cultural competence into physical therapy (PT) practice may reduce health care disparities and improve patient-centered care. Although several frameworks exist for teaching physical therapist students about cultural competence and cultural humility, discussion about which framework is comprehensive enough to capture the complexity of this topic is unresolved. The purpose of this position paper was to raise awareness in physical therapist and physical therapist assistant (PTA) education about existing frameworks of cultural competence and cultural humility and present a rationale for the inclusion of both in educational approaches. Position and Rationale. This article examines the concepts of cultural competence and cultural humility, explores the differences between these 2 concepts, and provides a rationale for integrating both theoretical constructs into PT and PTA education. Discussion and Conclusion. Cultural competence and cultural humility frameworks are evolving and so should faculty member approaches to teaching this content to PT students. Contemporary pedagogy requires a focused lens through which to prepare students for incorporating cultural awareness into clinical care to avoid potential cultural mismatches. Creating a new framework that synthesizes the principles of cultural competence and cultural humility may encourage more inclusivity. Cultural pedagogy has the potential to improve the patient experience and health outcomes by empowering students to provide care that is sensitive to important patient cultural differences.

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Disparities in Palliative and Hospice Care and Completion of Advance Care Planning and Directives Among Non-Hispanic Blacks: A Scoping Review of Recent Literature

Bazargan

Bazargan‐Hejazi

2020

Am J Hosp Palliat Care

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Objectives: Published research in disparities in advance care planning, palliative, and end-of-life care is limited. However, available data points to significant barriers to palliative and end-of-life care among minority adults. The main objective of this scoping review was to summarize the current published research and literature on disparities in palliative and hospice care and completion of advance care planning and directives among non-Hispanc Blacks. Methods: The scoping review method was used because currently published research in disparities in palliative and hospice cares as well as advance care planning are limited. Nine electronic databases and websites were searched to identify English-language peer-reviewed publications published within last 20 years. A total of 147 studies that addressed palliative care, hospice care, and advance care planning and included non-Hispanic Blacks were incorporated in this study. The literature review include manuscripts that discuss the intersection of social determinants of health and end-of-life care for non-Hispanic Blacks. We examined the potential role and impact of several factors, including knowledge regarding palliative and hospice care; healthcare literacy; communication with providers and family; perceived or experienced discrimination with healthcare systems; mistrust in healthcare providers; health care coverage, religious-related activities and beliefs on palliative and hospice care utilization and completion of advance directives among non-Hispanic Blacks. Discussion: Cross-sectional and longitudinal national surveys, as well as local community- and clinic-based data, unequivocally point to major disparities in palliative and hospice care in the United States. Results suggest that national and community-based, multi-faceted, multi-disciplinary, theoretical-based, resourceful, culturally-sensitive interventions are urgently needed. A number of practical investigational interventions are offered. Additionally, we identify several research questions which need to be addressed in future research.

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Living and Dying in a Disparate Health Care System: Rationale and Strategies for Cultural Humility in Palliative and Hospice Care Physical Therapy

Cited by 6 publications

References 48 publications

Preparedness for Serious Illnesses: Impact of Ethnicity, Mistrust, Perceived Discrimination, and Health Communication

Preparedness for Serious Illnesses: Impact of Ethnicity, Mistrust, Perceived Discrimination, and Health Communication

Cultural Competence and Cultural Humility: A Dialogue on Adopting a Multimodel Approach in Physical Therapist Education

Disparities in Palliative and Hospice Care and Completion of Advance Care Planning and Directives Among Non-Hispanic Blacks: A Scoping Review of Recent Literature

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