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Am J Hosp Palliat Care. 2019 Jun;36(6):453-459. doi: 10.1177/1049909119827933. Epub 2019 Feb 6.

Improving End-of-Life Care for Diverse Populations: Communication, Competency, and System Supports.

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1 Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
2 Department of Sociology, University of Alabama at Birmingham, Birmingham, AL, USA.



While disparities in end-of-life care have been well-documented, explanations for the persistence of disparities are less clear. This study sought to examine diverse perceptions of end-of-life care, especially regarding how medical professionals can better serve all populations.


To investigate similarities and differences in end-of-life care preferences, across racial and ethnic groups.


This work consists of a qualitative study utilizing in-depth focus group discussions.


Six community-based focus groups were conducted with a total of 39 participants. Two groups were composed of African American participants, 2 had Latino participants, and 2 groups had white participants.


Analysis produced 3 major themes: (1) clear, comprehensive, and culturally relevant provider-patient communication regarding serious illness; (2) provider characteristics and competency; and (3) health system supports and barriers. Although all groups had individuals who expressed a strong preference for direct communication, individuals varied within groups. All groups discussed concerns that the costs of care are high and that financial considerations are given more importance than high-quality care. Groups diverged in their focus on provider characteristics and feelings of marginalization. African American and Latino groups emphasized a desire to match characteristics with providers, and African American groups discussed that their marginalization in the health-care system requires hypervigilance to receive high-quality care.


Improvements in care would come from acknowledging diversity within groups, provider demonstration of comfort and competence, more effective care coordination, and recruitment of providers who share similar characteristics with the communities they serve.


cultural competency; health communication; health-care disparities; patient preference; qualitative research; terminal care


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