Core Modules

module 1 | Activity 3: Diverse experiences of dying and death

Diversity can have an impact on the way people approach dying and death – and the health decisions that they make when affected by a life-limiting illness.[1, 2]

Diversity is what makes a person or group unique and is not just associated with ethnic background. Diversity can be reflected in many ways including:[2-4]

  • Ethnicity and race
  • Culture
  • Language
  • Gender
  • Sexual orientation
  • Age and generation
  • Socioeconomic status
  • Disability status
  • Religion, faith and other beliefs.

Diversity influences health beliefs and practices, including beliefs about dying, death and bereavement. However, a person’s preferences cannot be assumed based on their identification with a particular group. Individual and family needs and preferences should be discussed to ensure that people receive the right care at the right time.[3, 5]

Culture is:[6-8]

  • The ‘lens’ through which we view the world and interpret or make sense of the experiences of life, including illness, dying and death
  • A system of interrelated values that influence patterns of thought, behaviours, communication styles and beliefs about life and death
  • A dynamic construct. Values and beliefs can change from one generation to the next depending on life experiences.

Cultural groups can vary according to where people live (urban, rural or remote regions), their environment and education.

In the context of dying and death, culture can influence:[5, 7-9]

  • Language and communication styles
  • Beliefs about illness and ill health
  • Family involvement in care
  • Expression of pain and other symptoms
  • Meaning of life, dying, death, and grief
  • Practices associated with care immediately after death
  • Beliefs about what happens to the body after death
  • Use of complementary and alternative therapies.

 

Australia is a highly diverse and multicultural society.

Australia’s culturally and linguistically diverse population includes people who were born overseas, have a parent born overseas or where English is not their main language.[7, 10]

In 2021:[10]

• 29.3% of Australians were born overseas

• 22.1% of Australians had one or both parents born overseas

• 22.8% of Australians spoke a language other than English at home.

Of Australians who are aged 65 years or over, 37% were born overseas.[11]

 

Cultural diversity and intersectionality

Intersectionality can be described as ‘diversity within diversity’. Intersectional risk means that some individuals, especially those who belong to multiple diverse population groups are more vulnerable than others. These groups include, older people, LGBTIQ+ people, those living with dementia, chronic disease or disability, those suffering financial disadvantage and/or at risk of homelessness, refugees, and people living in rural or remote areas. Person and family-centred care can address intersectional risk by ensuring that care is responsive to individual needs and preferences.[12]

 

Cultural safety and its application to palliative care 

It is important to acknowledge cultural and linguistic diversity and to provide care and support according to people’s preferences. Your personal attitudes and beliefs can distort how you perceive people from different cultures and diverse groups.

Cultural safety provides an important framework for palliative care. It involves health professionals examining their own beliefs, behaviours and practices, as well as issues such as institutional racism, to ensure that their services are perceived as safe by the person receiving care.[8]

Cultural safety is a framework developed by Māori nurse, Irihapeti Ramsden in the late 1980s. It extends beyond cultural awareness and cultural sensitivity and aims to ensure that the care provided meets the person’s cultural needs and promotes feelings of being safe.[6] Cultural safety provides the framework in which to deliver culturally-responsive care.[13]

Additional learning on cultural safety and culturally-responsive care is provided in the Pre-requisite knowledge section of PCC4U Focus Topic 2.

  1. Research the relevant cultural safety standard for your health professional group. Describe the key elements of cultural safety and their implications for the care of people with a life-limiting illness.
  2. What would you do to avoid stereotypes and ensure that your practice is culturally-responsive and encompasses diversity in all of its forms for everyone in your care?
  3. How can health and ages care services create a culturally-safe care environment for people who are dying?
  4. Find out how to access professional interpreter services in your practice context when caring for people with a life-limiting illness who require this support.
  1. Murray, S.A., et al. 2017. Palliative care from diagnosis to death. BMJ, 356.
  2. Hayes, B., et al. 2017. Health and death literacy and cultural diversity: insights from hospital-employed interpreters. BMJ Support Palliat Care.
  3. Crawford, T., S. Candlin, and P. Roger, 2017. New perspectives on understanding cultural diversity in nurse-patient communication. Collegian. 24(1): p. 63-9.
  4. Jhutti-Johal, J. 2013. Understanding and coping with diversity in healthcare. Health Care Anal. 21(3): p. 259-70.
  5. Halm, M.A., et al., 2012. Broadening cultural sensitivity at the end of life: an interprofessional education program incorporating critical reflection. Holistic Nursing Practice. 26(6): p. 335-349.
  6. Bozorgzad, P., et al. 2016. Cultural Safety: An Evolutionary Concept Analysis. Holist Nurs Pract. 30(1): p. 33-8.
  7. Laverty, M., D. R McDermott, and T. Calma. 2017. Embedding cultural safety in Australia’s main health care standards. Vol. 207. 15-16.
  8. Huntir, A. 2018. Cultural safety crucial in Aboriginal and Torres Strait Islander healthcare.
  9. Wiener, L., et al., 2013. Cultural and religious considerations in pediatric palliative care. Palliative & Supportive Care. 11(1): p. 47-67.
  10. Australian Bureau of Statistics. 2022. People and Communities: Snapshot of Australia 2021
  11. Australian Institute of Health and Welfare. 2023. Culturally and linguistically diverse older people
  12. Kelly, C., Dansereau, L., Sebring, J. et al. 2022. Intersectionality, health equity, and EDI: What’s the difference for health researchers?. Int J Equity Health 21, 182.
  13. Indigenous Allied Health Australia. 2019. Cultural Responsiveness in Action: an IAHA Framework