Philadelphia Inquirer Series on End-of-Life Care Focuses on Communication ‘Chasm’ Between African-American Patients and Their Doctors

Cultural and language barriers often prevent doctors and minority patients from effectively treating pain and addressing patients' needs during end-of-life care, the Philadelphia Inquirer reports. As part of a 15-part series, "Finding our Way: Living With Dying in America," the Inquirer details the experiences of a 78-year-old African-American woman with cancer to illustrate how a "communication gap of intercultural medical care" between the "mostly white medical establishment" and patients from a variety of minority cultures can adversely affect end-of-life care and "influence doctor-patient integrations." The woman, called Ira, was diagnosed with acute myelogenous leukemia, but because she "found doctors untrustworthy," she did not believe her diagnosis. Her denial of her cancer was "part of her struggle to get care she felt she'd been denied most of her life," the Inquirer reports. But Ira's doctors did not know that her "refusal to accept her cancer and impending death were symptoms of a profound mistrust." Ira died within one month of her last hospitalization, "having never accepted her condition." How she "lived and died speaks volumes about the challenges America faces in the coming years, as million of baby boomers and their parents reach the dying stage of life," the Inquirer reports. In particular, pain and its treatment "play a key role in America's cultural divide over end-of-life care." For example, a 1998 study of nursing homes found that compared with white patients, black patients "consistently reported" that their pain was not treated "adequately." Communication and language issues also play a part in the end-of-life care divide. A 1995 study found that relaying "bad news" to patients of some ethnic groups may cause harm if not delivered in a way that "recognizes cultural values." Some Hispanic groups, for example, consider frank discussions about death as a "loss of hope." Cultural differences also create "major barriers" for minority participation in hospice and palliative-care services, the Inquirer reports. Many minorities view such programs as "medical abandonment" instead of an effort to comfort patients (Crawley, Philadelphia Inquirer, 12/17).