Advanced Care Planning

Intercultural dynamics leading to misunderstanding:

  1. Lack of acceptability of discussion of death or disability in the culture.
  2. Cultural, social, economic, educational, and linguistic differences between provider and patient/family.
  3. Historical persecution or oppression of the patient/ethnic group leading to distrust of providers.
  4. Variation by ethnic group and sub-group in knowledge of advance directives
  5. Cultural rituals and traditions at the time of death.
  6. 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.
  7. Multicultural influences during lifetime of patient.
  8. Is patient capable of identifying person(s) responsible for medical and financial decisions?
  9. Does the family accept the identified decision maker?

Techniques to minimize confusion and misunderstanding:

  1. Self-assess provider’s own values and culture about death.
  2. Use cultural guides for culturally appropriate interaction.
  3. Ask patients to describe their customs, concerns, and beliefs about death, if appropriate.