What components within culture effect end of life?
- Ethnic identity
Although someone may be of a particular ethnic group, they may not identify strongly with that group. Perceptions of the end of life, afterlife, grief etc. vary widely by ethnicity and within cultures. - Gender
Gender factors influence both patients and family caregivers. Much of the end of life care in the U.S. is administered by females. These females are often elderly wives or daughters of the dying person. Gender biases exist in this system. For example, discussions with family members at the end of life may be directed towards the male head of family or oldest son in more traditional cultures. - Age
Age can influence many factors. For example, perceptions of pain often vary with age. Elders may perceive that pain is expected or that they should not complain (e.g., be a bad patient). - Differing abilities
People with differing abilities, physical or mental health variations, are often stigmatized or treated in an infantile manner. People with differing abilities and their families may feel alone and ostracized. “Differing abilities” has varied meanings across various cultures. In the U.S., legal efforts have been focused on insuring that people with disabilities are entitled to the same rights as other individuals. - Sexual orientation
Gay, lesbian, and transgendered individuals are often stigmatized. An inoffensive strategy when asking questions about sexual orientation is to state, “If you are sexual with others, are they men, women, or both?” - Religion and spirituality
Religion is a system of faith and worship. Spirituality is the feeling of interconnectedness with a higher power. Some patients and families find comfort in the rituals associated with their beliefs. The spiritual assessment is represented by the acronym FICA: Faith, Importance, Community, and Address. - Financial status
Socioeconomic status has a strong influence on all aspects of health care. End-of-life care may financially deplete families with limited resources. Families may be reluctant to reveal their resources out of embarrassment or other factors. An estimated 25% of families are financially devastated by a serious terminal illness. - Place of residency
Homeless individuals and those in prison often have disorders of mental illness, substance abuse, and low socioeconomic status. Their access to care is limited and they are often ostracized by society and the healthcare system. - Employment
Employment is associated with socioeconomic status. Patients may also derive self-identity and self-worth through their jobs or professions. As illness progresses and participation in work becomes impossible, patients may feel a crisis in knowing their “self.” - Educational level
Educational level is related to socioeconomic status. Those with higher educational levels generally have greater resources. Education influences all aspects of life. - Causes of death
Social and racial differences impact causes of death. Minority populations have higher deaths due to injury, HIV infection, homicide and suicide.
Culture influences all aspects of life, especially illness and end-of-life care. Various cultures hold different beliefs about death and dying. Health care providers must be aware of the beliefs of patients in their care. Culturally sensitive care is best provided through an interdisciplinary approach. Social workers, psychologists and chaplains offer tremendous support in cultural assessment.
