Focus Topics

topic 4 | Activity 2: Diversity and palliative care

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 ethnicity, cultural background, language, religion, gender, sexual orientation, age, socioeconomic status and disability status.:[1-3]

Diversity influences health beliefs and care 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.[2, 4]

This content is covered in more depth in Core Module 1: Activity 3

Barriers to palliative care

A recent report by the Australian Government has highlighted that there are various groups of people in our communities who experience barriers to the provision of palliative care. These include:[6]

Underserved populations: People living with different types of vulnerability:
  • Aboriginal and Torres Strait Islander peoples
  • People from culturally and linguistically diverse backgrounds
  • LGBTIQ+ peoples and communities
  • Ageing or frail people, particularly those living in residential aged care
  • People living in rural and remote areas
  • Refugees
  • Veterans
  • Prisoners.
  • Homelessness
  • Disability
  • Mental health concerns
  • Institutional care experiences in childhood
  • Social isolation
  • Economic disadvantage
  • Survivors or trauma.

It is important to note that there is considerable diversity among people within and between these groups. There are also many people who experience more than one of these types of vulnerabilities. What these diverse groups have in common is that they all experience barriers to accessing palliative care.[6]

A history of disadvantage, marginalisation and trauma contributes to an increased risk of chronic disease and life-limiting illness, and therefore an increased need for palliative care, especially later in life. Unfortunately, the cultural and personal factors involved contribute to significant barriers to accessing healthcare, particularly palliative care. This can mean that those who have the greatest need for palliative care, are among those least likely to receive it.[6]

The most important strategy for improving access to palliative care is to shift from providing special care to people from underserved populations to providing inclusive care to all people.[6]

  1. Think about someone you have cared for from a diverse cultural background. What cultural considerations were associated with caring for them?
  2. What were things you could have done to improve the situation?
  1. Hayes, B., et al. 2017. Health and death literacy and cultural diversity: insights from hospital-employed interpreters. BMJ Support Palliat Care.
  2. Crawford, T., S. Candlin, and P. Roger, 2017. New perspectives on understanding cultural diversity in nurse-patient communication. Collegian. 24(1): p. 63-9.
  3. Jhutti-Johal, J. 2013. Understanding and coping with diversity in healthcare. Health Care Anal. 21(3): p. 259-70.
  4. 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.
  5. Australian Government, Department of Health (2020), Exploratory Analysis of Barriers to Palliative Care – Summary Policy Paper.