Palliative care is an important part of the health care continuum. Up to 90 per cent of people at the end of life prefer to be cared for and to die comfortably at home, yet Australia has one of the lowest rates in the world of people dying outside of hospital or in residential aged care. We need to get better at supporting end-of-life choices around comfort and dignity and improve access to palliative care at home.
Understanding the Palliative Care Continuum
The palliative care continuum can support people from the point of diagnosis of a life-limiting illness through to end-of-life care and bereavement. It is not limited to the final days of life and can be provided alongside other treatments to manage symptoms, improve quality of life and support families. For multicultural communities, access to this continuum should include culturally responsive communication, appropriate language resources and care that recognises individual preferences around family, spirituality, place of care and decision-making.
A person-centred approach to palliative care must account for cultural and individual needs. Yet we know that these same cultural factors sometimes in fact pose barriers to community members accessing the benefits of palliative care and the support available to die well.
Culturally Responsive Palliative Care for Diverse Communities
Effective palliative care for multicultural communities requires more than translating information. Health services need to understand how culture, language, family relationships, spirituality and previous experiences with healthcare can influence decisions about illness, treatment and end-of-life care. Community engagement can help services identify these barriers and develop more accessible approaches. For Larter, this means supporting health organisations to consider local community needs when designing communication, engagement and service access strategies for culturally diverse populations.
There is low awareness and use of palliative care services among some culturally, linguistic and spiritually diverse communities. Among others, there are beliefs and values which impact on perspectives of death and dying, and therefore accessing end-of-life services. For example, religion, attitudes to family and filial piety, to illness and pain management, to mental health, and to receiving care or care in the home can all impact on individuals and families’ willingness to engage.
Culturally responsive palliative care must be sensitive to these beliefs and must also continue to improve whole-of-community’s understanding of the quality of life benefits to accessing palliative support earlier in the illness journey, by changing the conversation to a focus on symptom management and comfort. As we move towards inclusive community approaches to dying in Australia, such as Compassionate Communities, which enhance the informal care networks around people at the end of life, we need to be even more sensitive to family-centred and community-centred approaches to care.
Improving Access to End-of-Life Care at Home
For many people, receiving end-of-life care at home can provide comfort, familiarity and greater involvement of family and informal carers. However, access depends on appropriate community-based services, clear information and support that reflects the needs of different cultural communities. Local healthcare services can improve access by working with community organisations, multicultural groups and carers to understand barriers and create culturally appropriate pathways into palliative care.
More inclusive and responsive services to palliative care: Engaging multicultural communities
Palliative Care South East delivers home-based care to people living with a life-threatening illness in the south east of Melbourne, which includes the multicultural hub of Dandenong and surrounds. The service is cognisant of the changing demographics in its catchment and continues to review its engagement approach to be responsive to local community needs.
Other examples: Dari poster, Farsi poster, Khmer poster
Family caregivers and carers have a unique role in supporting someone at the end of life. Their roles and wellbeing are critical to ensuring a person’s end-of-life choices can be maintained. A Carer Support Kit translated into 10 community languages is also available from Palliative Care South East.
Conclusion
Improving end-of-life care for multicultural communities requires services that recognise cultural, linguistic, family and spiritual needs alongside clinical needs. A more inclusive palliative care continuum can help people access appropriate support earlier, make informed end-of-life choices and receive care in settings that reflect their preferences. By working with multicultural communities, carers and local healthcare organisations, Larter supports more culturally responsive approaches to palliative care that promote dignity, comfort and equitable access to care.
Frequently Asked Questions
Services can improve cultural responsiveness by engaging local communities, using appropriate language resources, involving families and carers, and adapting communication and care approaches to individual cultural and spiritual preferences.
Barriers may include limited awareness of available services, language differences, cultural beliefs about illness and dying, concerns about receiving care outside the home, and difficulties navigating health and support systems.
Community engagement helps health services understand local beliefs, preferences and access barriers, allowing them to design palliative care information and pathways that better reflect the needs of diverse populations.
Families can help communicate a person’s preferences, participate in care discussions when appropriate, support decision-making and work with healthcare providers to ensure cultural and spiritual needs are respected.
Carers can provide practical, emotional and social support while helping individuals maintain their preferred place and approach to care. Appropriate information and carer support are important throughout the end-of-life journey.