Integrating cultural sensitivity into palliative and end of life care

Diversity Rx Conference:
Quality Health Care for Culturally Diverse Populations
Peer to Peer Practice Advancement Session
Linda Kongnetiman: Child and Women’s Health Diversity Program
Introduction to the program and current research
The Child and Women’s Health Diversity Program under the umbrella of the Southern Alberta Child and Youth Health Network, in the Calgary Health Region came into being six years ago.  This was as a result of the increasing number and diversity of immigrants and refugees in Southern Alberta, and the health care system’s inability to accommodate the health care needs of these newcomers.  Canada has a long history of immigration and two-thirds of Canada’s population growth between 2001 and 2006 was fuelled by recent immigrants. The city of Calgary is the fourth receiving city of immigrant and refugee families who migrate to Canada, in hopes of a better life and more opportunities.  Calgary, when compared to Toronto or Vancouver, has relatively few immigrants (the ratio in Toronto will reach 1:1 by 2017, and currently in Calgary the ratio is 1:5).  In Calgary, the five most prevalent ethno-cultural groups are Chinese, South Asians (India and Pakistan), Filipino, and Koreans, and 21% of the Calgary population are culturally diverse children under the age of 17.  The experiences faced by new immigrants to Calgary often do not satisfy their expectations, and sometimes they face unexpected challenges when accessing the health care system.  These challenges are even more daunting when the family has a child with a disability, when the child is seriously ill, or when a child has died.
The migration of immigrants who have different cultural and religious values, beliefs, and traditions than North Americans is pressuring Health Care Professionals and services to become more culturally competent when providing pediatric palliative care.  Within the health care setting, there was a recognized need for cultural competence on the part of healthcare professionals.  This need required that professionals be able to respond appropriately and in a timely fashion to people of all cultures, backgrounds and religions in a manner that recognized, affirmed and valued cultural differences and similarities.
In conjunction with the University of Calgary and the Grief and Palliative Care Team, the Child and Women’s Health Diversity Program conducted research on the topic of understanding cultural competency in pediatric palliative care.  The purpose of the study was:
·        To gain knowledge and increase understanding of the values and beliefs of the ethno-cultural community when a child is palliative or has died;
·        To examine the level of care received as perceived by parents from the ethno-cultural community;
·        To understand the role and functioning of the ethno-cultural specific organizations as social supports for families;
·        To examine the level of understanding of health care professionals working with these families and their learning needs.
Both individual and group interviews were conducted among families, key informants, religious leaders, and Health Care Professionals.  The ethno-cultural communities involved included Chinese, Filipinos, Sudanese, Middle-Easterners, South Asians and Hutterites.
Innovations and Findings
            The role of the Child & Women’s Health Diversity Program is to support, enhance and develop culturally competent services.  The program strives to facilitate and promote culturally competent care which acknowledges and respects different cultural beliefs, values and perceptions of health and illness.  There are several ways we do this:

• We offer clinical consultation with Health Care Professionals and, less frequently, families, regarding diagnosis, care, treatment and other issues as requested or needed in situations where cross-cultural beliefs or practices are present and are not well-understood by staff
  
• We offer cultural competency training and workshops to educate staff and to enhance cross-cultural sensitivity and culturally competent service delivery.  Education sessions are experiential and interactive and focus on skill-building, small group activities, role playing and case study discussions.  A complete training includes four, three-hour modules which are entitled:
  
• Self Assessment and World Views on Health and Illness
  
• Personal Cultural Values, Biases and Stereotypes
  
• Culturally Responsive Assessment and Diagnosis
  
• Cultural Competency in My Program/Clinic
  

• We offer families, professionals and community partners access to resources which include a wide variety of clinical and community resources, many in translated versions, regarding child health conditions and treatment options.  We have also developed several of these resources, which include:
  
• Enhancing Cultural Competency: A Resource Kit for Health Professionals
  
• The training modules already referred to
  
• Cultural Competency Check Card
  
• Immigrant and Refugee Women’s Cultural Health Practices
  
• Community Resources for Newcomers
  
• We are in the process of developing more resources (FAQ document, Counseling Practices Around the World, Cultural Competence in Pediatric Palliative Care)
  
• The program also works closely with the Interpretation and Translation Service of the Calgary Health Region to ensure that children and families have access to medically trained interpreters during their health care experience.
  

Lessons learned/challenges overcome
Incorporating ethno cultural communities who are usually not accessed into the development of programs and research.
Finding different research methodologies that meet the needs of the communities involved.
Continuing to find creative ways of having upper level management as well as front line workers interested in ongoing training and education.