Intercultural dynamics leading to misunderstanding:
- Lack of acceptability of discussion of death or disability in the culture.
- Cultural, social, economic, educational, and linguistic differences between provider and patient/family.
- Historical persecution or oppression of the patient/ethnic group leading to distrust of providers.
- Variation by ethnic group and sub-group in knowledge of advance directives
- Cultural rituals and traditions at the time of death.
- Biomedical model of autonomy in decision making that does not recognize cultural expectations that others (e.g., family, son, clan leader) would make health care decisions for elder.
- Multicultural influences during lifetime of patient.
- Is patient capable of identifying person(s) responsible for medical and financial decisions?
- Does the family accept the identified decision maker?
Techniques to minimize confusion and misunderstanding:
- Self-assess provider’s own values and culture about death.
- Use cultural guides for culturally appropriate interaction.
- Ask patients to describe their customs, concerns, and beliefs about death, if appropriate.
