In a nation of diverse cultures, Cultural Care is of paramount importance in an equitable and accessible health care system – but Australia is falling short of providing the levels of care needed in end-of-life situations by this significant proportion of our population.
Research by Dr Oluwatomilayo (Tomi) Omoya, a lecturer in Nursing (Teaching & Research) from Flinders University’s College of Health and Enablement, has found that many people from culturally and linguistically diverse backgrounds don’t get the right support when they, or someone they care for, are nearing the end of life.
Dr Omoya found there are language barriers, cultural differences, and sometimes a lack of trust or understanding of the health system from people of diverse cultures.
For families and carers, this can make an already difficult time even more stressful and isolating. Some people who take on the responsibility of careering for people in end-of-life situations don’t even identify as carers or know where to get help.
“End-of-life care should be respectful, safe, and aligned with a person’s beliefs and values, but currently this doesn’t always happen for CALD communities,” says Dr Omoya. “When care is not culturally appropriate, people may avoid services or receive care that doesn’t meet their needs.”
Dr Omoya’s research aims to better understand the experiences of carers and health professionals, and where the gaps are.
“The goal is to improve how care is delivered so it is practical, inclusive, and easy to access. This will directly support patients, families, carers, and clinicians working in palliative and acute care settings,” she says.
During the next year, Dr Oyoma will focus on engaging specific CALD communities to explore their lived experiences with end-of-life care, followed by translating findings into practice through co-designed, culturally responsive care models that ensure CALD-informed palliative care strategies are embedded into clinical practices.
Another part of Dr Omoya’s research is focused on Emergency Departments in hospitals, where end-of-life care is often required in a setting where the medical staff’s energy is usually focused only on repairing and sustaining life.
Dr Omoya says creating an open discussion about the role of Emergency Department doctors and nurses in providing end of life care has brought forward many interesting perspectives about each person’s perceived roles within the larger care system.
A doctor recognised the large amount of intensive nursing required when end-of-life care becomes a priority in an emergency department, while one of the nurses surveyed saw their role as providing emotional support, to make sure that a person is quite comfortable. Other staff pointed to areas where their colleagues can improve to best support end-of-life care.
“One nurse participant in the study said doctors should be using plain English language to express what is going on in end-of-life situations, to make sure that family members actually understand,” says Dr Omoya. “Because the doctor is the first person to have that discussion with a family, the nurse specified that a doctor’s explanation needs to be especially clear and concise.”
She is also evaluating an improved Palliative Care Education Program for Paramedics, which recognises that paramedics play a critical role in aligning care with end-of-life wishes to promote a person-centred approach.
While palliative care education enhanced paramedics’ knowledge and skills, Dr Omoya identified knowledge gaps in the study that revealed a need for training to improve a paramedic’s ability to manage complex palliative care needs within the community.
She is pleased that such research is helping to provided clear ways of enhancing patient-centred care and autonomy for patients needing end-of-life and palliative care – and this is especially relevant for people from CALD communities who need specific assistance in emergency departments or from paramedics.
While this research is based in Australia, she emphasises that the issues it addresses are not unique to one place. “Many countries are becoming more culturally diverse, so the findings of these studies can apply more broadly,” says Dr Oyoma.