Author Affiliations: Community Health Sciences, University of California, Los Angeles School of Public Health and Asian American Studies (Dr Kagawa-Singer); Center for Palliative Care and Research, and Center for Biomedical Ethics, University of Virginia, Charlottesville (Dr Blackhall).
Perspectives on Care at the Close of Life Section
Editor: Margaret A. Winker, MD, Deputy Editor, JAMA.
Culture fundamentally shapes how individuals make meaning out of illness,
suffering, and dying. With increasing diversity in the United States, encounters
between patients and physicians of different backgrounds are becoming more
common. Thus the risk for cross-cultural misunderstandings surrounding care
at the end of life is also increasing. Studies have shown cultural differences
in attitudes toward truth telling, life-prolonging technology, and decision-making
styles at the end of life. Using 2 case studies of patients, one of an African
American couple in the southern United States and the other of a Chinese-American
family in Hawaii, we outline some of the major issues involved in cross-cultural
care and indicate how the patient, family, and clinician can navigate among
differing cultural beliefs, values, and practices. Skilled use of cross-cultural
understanding and communication techniques increases the likelihood that both
the process and outcomes of care are satisfactory for all involved.
Kagawa-Singer M, Blackhall LJ. Negotiating Cross-Cultural Issues at the End of Life"You Got to Go Where He Lives". JAMA. 2001;286(23):2993-3001. doi:10.1001/jama.286.23.2993