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American Journal of Hospice and Palliative Medicine®
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Programmatic barriers to providing culturally competent end-of-life care

Dona J. Reese, PhD, MSW

School of Social Work, University of Arkansas, Fayetteville, Arkansas

Elizabeth Melton, BASW

Benton County Department of Human Services, Bentonville, Arkansas

Karen Ciaravino, BASW

Benton County Department of Human Services, Bentonville, Arkansas

Despite many efforts to increase access to end-of-life care, culturally diverse groups are still not being served. Interviews of 22 hospice and palliative care program directors in one southeastern state indicated that directors overestimated how well programs are doing in meeting the needs of diverse groups but were very interested in implementing cultural diversity training for their staff. Those who were more concerned about such issues had recruited more diverse volunteers into their programs. The presence of diverse staff or volunteers predicted a more diverse patient population. A number of efforts were underway to develop cultural competence and provide culturally competent care. Several directors reported no efforts in this direction, however. Directors described programmatic barriers and resources needed. The authors concluded that directors should provide leadership in their agencies in welcoming diversity. Implications for further research and work within the larger end-of-life care field are discussed.

Key Words: end-of-life care • palliative care • hospice • cultural competence • diversity • racial minorities

American Journal of Hospice and Palliative Medicine®, Vol. 21, No. 5, 357-364 (2004)
DOI: 10.1177/104990910402100510


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