Palliative Care

Culture is a fundamental part of one’s being which along with spirituality play a significant role in a person’s journey through life. Health beliefs may be strongly tied to a person’s cultural background and spiritual or religious affiliation. Palliative care is the active holistic care of terminally ill patients which demands to maintain the quality of life addressing physical symptoms as well as emotional, spiritual and social needs. This very nature of the palliative care poses challenges to health care workers when addressing a culturally diverse population. Australia is the most multicultural country in the world where its population ranges from the descendants of Aboriginal and Torres Strait Islander people to migrants or of descendants of migrants from more than 200 countries. The aim of this essay is to discuss the importance of providing spiritually and culturally competent care for a person and their family receiving palliation. This essay also discusses how importance is to focus these principles to the culture of Aboriginal and Torres Strait Islander people with regards to death and dying.

World Health Organisation defines palliative care as “ an approach that improves the quality of life of patients and their families facing with life threatening illness through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual”(WHO,2009) . According to Matzo & Sherman (2010) the culture and spirituality are among the most important factors that structure human experience, values and illness patterns and determine how a person interact with the healthcare system. Moreover a person’s beliefs, values, rituals, and outward expressions can impact palliative care either positively or negatively. According to Brown & Edwards (2012) people experiencing the

inevitability of death are in need of care givers who are knowledgeable about personal issues and attitude that affect the end of life experience.

An adequate understanding of cultural and spiritual matters is vital and beneficial when focussing on dying person’s family needs and wants. According to Geoghan (2008) perception differ among culture in issues such as use of medication, personal space and touching, dietary issues, whether to be cared at home or seek health care facility. Long (2011) states that when determining the decision making and disclosures culture has a significant role to play with spiritual or religious implications. Brown & Edwards (2012) states that culturally expressions physical symptoms especially pain differs in different cultures and leads to ethnic minority groups are often being undertreated in terms of pain medication. Moreover, nonverbal cues such as grimaces, body positions and guarded movements also significance in providing culturally competent care.Ferrell &Coyle (2010) states language has an important role in streaming communication patterns and style between health providers and patients and lack of effective communication may mean less than satisfactory exchanges between health providers, patients and their families in a multicultural society.

According to Matzo & Sherman(2010) spirituality is a way to be connected with God as well as to self, fellow human beings and to nature. Moreover, when the terminally ill patients go through critical life adjustments, spirituality considered to be as a domain of palliative care which serves as the binding force for physical, social, and psychological domains of life. According to Ferrell &Coyle (2010) majority of the palliative patients may experience a

growth in spirituality and considers spirituality to be one of the most important contributors to quality of life and frequently used as helpful coping strategies for their physical illness.
Furthermore, the family caregivers of seriously ill patients also find comfort and strength from their spirituality and considerably assist them in coping .At the same time many of such patients with their uncertainty of life, long term nature of illness, potential for pain, altered body image and confrontation of death may lead to spiritual distress as well (Matzo & Sherman, 2010).

Spiritual care is an important factor for both those expressing spiritual wellness and those experiencing spiritual distress during their period of illness (Amoah, 2011). Matzo & Sherman (2010) states that spirituality facilitate coping with chronic pain, disability, sense of illness and provides strength and self-control and thus reduce the anxiety and depression. Furthermore, those who participate in religious services and ceremonies experience a relief from their loneliness and isolative life style and such practices may generate significant support and peace in difficult times for the patient and their family. Brown & Edwards (2012) states that assessment of spiritual need in palliative care is a major factor because spiritualty is not necessarily equate religion and a person do not have particular faith or religion may have deep spirituality.

According to Brown & Edwards (2012) awareness and sensitivity to cultural beliefs and practices regarding death and dying is vital when caring end of life patients, especially in a multicultural societies such as Australia. Ferrell & Coyle (2012) states that in spite of strong government initiatives, Aboriginal and Torres Strait Islander people remain a marginalised group with health status significantly below that of other Australians.
Consequently Aboriginal and Torres Strait Islander people have high rate of mortality and premature death (McGrath & Philips, 2009). Furthermore, Ferrell & Coyle (2012) states that while addressing palliation of Aboriginal and Torres Strait Islander people, culturally responsive model of palliative care to be delivered and traditional practices that surrounds care of dying people and death are understood, respected and incorporated in to care. According to Thackrah & Scott (2011) an understanding of cultural, practices, protocols and customs with regards loss and grief is of topmost priority when dealing with traditional aboriginal men and women.

According to Queensland Health (2013) Aboriginal and Torres Strait Islander have strong cultural and spiritual concepts about the cause of diseases and death which may conflict with Western explanations and diagnosis of illnesses. According to McGrath & Philips (2008), though the Indigenous Australians adopted many aspects of the non-Indigenous culture over the years, their expectations and rituals around end of life still mostly well connected to their land, culture and tradition. Most of the Aboriginal people have a strong wish to die at home with family, surrounded by their ‘Country’ and in their own community where their spirit belongs (O’Brien &Bloomer, 2012). According to Thackrah & Scott (2011), most people dislike the hospital environment because they believe in the hospital they may experience isolation, structural racism and disempowerment. Since death in a hospital can create stress in the family along with fear and disputes, family protocols to be strictly followed and they have to be given space to finish up with dignity and compassion.

During a situation of an expected death of an Aboriginal or Torres Strait Islander person, there is usually a gathering of immediate and extended family and friends which are a mark of respect of the patient. Based on the belief that life is a part of a greater journey, it is cultural practice to prepare the person for the next stage in their journey and often the extent of gatherers correlates with the patient’s value to the community. The passing of an elder may induce immense grief and mourning upon the whole community, hence expect many visitors and a grand funeral ceremony that reflects the respect. According to Thackrah & Scott(2011),When a death occurs in traditional indigenous communities in Australia, community members and visiting relatives from elsewhere move away from settlements into a special place called ‘‘sorry camp’’. Also the Indigenous way of grieving is a long process with different phases not only consoling each other but by traditional ways of harming themselves.

Palliative care is truly a holistic care delivered to patients and family members with life threatening illness by providing physical as well as emotional and spiritual support. It is evident that culture and spirituality are central to palliative care which must be given due consideration at every point of assessing and planning care for patients and families. Although spiritual beliefs might help most people to cope well in the face of illness, for other people such beliefs may be ineffective or problematic. Since health beliefs are strongly associated with culture and spirituality it is critical that healthcare professionals understand and implement best practices in attending to cultural and spiritual needs during their illness journey. The death and dying in Aboriginal and Torres Strait Islander people have a crucial cultural significance and health professional must be competent in religious and cultural practices when addressing palliative care.

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