Cross-Cultural Considerations in Promoting Advance Care Planning ...

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Recommendations Advanced Care Planning in Canada curriculum including ACP, cross-cultural considerations and specific communication/counselling skills needed for EOL care. • Professional schools should provide incentives for non-mainstream students to complete their studies and establish their practices in high-need communities. • The Canadian Medical Association or Health Canada should make Palliative Care an official Medical Specialty offered as part of the continuity of care throughout hospitals and care facilities. ACP requires considerable time and resources which a Palliative Care team could be responsible for. • There is a need for national and provincial funding agencies to provide research dollars for palliative and EOL care research. • Further research on ACP is also required. ACP is not an exclusive palliative care concept although it is often associated with EOL. For example, it is not clear when ACP would be most effective (i.e., primary care, initial diagnosis, palliative). • Organizations/health care facilities should create pathways to help guide HCP in their ACP conversations. By providing support and direction, this will assist in dealing with patients who are and are not comfortable with ACP discussions. • To implement ACP, HCP require training and/or a team (e.g., physician, nurse, social worker, psychologist, chaplain) that not only can handle ACP but is also skilled in dealing with diverse minority groups. Those who open up these types of discussions without training are ill-equipped to deal with the emotional reactions of patients and families and can do more harm than good. Specialized training will also address the concerns of HCP who are not comfortable with conducting the ACP conversation. • It is important to be respectful of all people, regardless of culture. When a loved one is dying, the situation is particularly emotional and stressful. ACP can be a useful tool to help bring the family together to discuss what is in the best interest of the patient and help make decisions that not only comply with patient wishes but also direct HCP in their care. • Engage communities to develop outreach programs to ensure that everyone knows about and has access to adequate services. Page 43
Advanced Care Planning in Canada Bibliography Aitken, P. V., Jr. (1999). Incorporating advance care planning into family practice. American Family Physician, 59(3), 605-14. Alibhai, S. M., & Gordon, M. (2004). Muslim and Jewish perspectives on inappropriate treatment at the end of life. Archives of Internal Medicine, 164(8), 916-7; author reply 917. Allard, P., Brajtman, S., Brazil, K., Guirguis-Younger, M., Legault, F., McPherson, C., et al. (2003). Optimizing research on end-of-life care for seniors: The collective new emerging team on end of life care for seniors, University of Ottawa, Institute of Palliative Care. Geriatrics Today, 6(3), 173-176. Allen, B., Meyers, N., Sullivan, J., & Sullivan, M. (2002). American Sign Language and end-of-life care: Research in the deaf community. HEC forum, 14(3), 197-208. al-Shahri, M. Z., & al-Khenaizan, A. (2005). Palliative care for Muslim patients. The Journal of Supportive Oncology, 3(6), 432-6. Ankeny, R. A., Clifford, R., Jordens, C. F., Kerridge, I. H., & Benson, R. (2005). Religious perspectives on withdrawal of treatment from patients with multiple organ failure. Medical Journal of Australia, 183(11-12), 616-21. Arenson, C. A., Novielli, K. D., Chambers, C. V., & Perkel, R. L. (1996). The importance of advance directives in primary care. Primary Care, 23(1), 67-82. Ariff, K. M., & Beng, K. S. (2006). Cultural health beliefs in a rural family practice: A Malaysian perspective. Australian Journal of Rural Health, 14(1), 2-8. Astrow, A. B., Puchalski, C. M., & Sulmasy, D. P. (2001). Religion, spirituality, and health care: Social, ethical, and practical considerations. The American Journal of Medicine, 110(4), 283-287. Baker, M. E. (2000). Knowledge and attitudes of health care social workers regarding advance directives. Social Work in Health Care, 32(2), 61-74. Barry Ashpole and Associates, Inc. (2005). Advance care planning - An environmental scan. Final report. March 23rd, 2005. Prepared for the Secretariat on Palliative and End-of-Life Care, Health Canada. Baydala, A., Hampton, M., Kinunwa, L., Kinunwa, G., & Leon, K.,Sr. (2006). Death, dying, grieving, and end of life care: Understanding personal meanings of Aboriginal friends. The Humanistic Psychologist, 34(2), 159-176. Becker, G. (2002). Dying away from home: Quandaries of migration for elders in two ethnic groups. Journals of Gerontology Series B-Psychological Sciences & Social Sciences, 57(2), S79-95. Bélanger, A., & Malenfant, E. C. (2005a). Ethnocultural diversity in Canada: Prospects for 2017. Canadian Social Trends, 79. (Statistics Canada Catalogue No. 11-008, pp. 18-21). Retrieved from http://www.statcan.ca/ Page 44
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