How to discuss hospice care with Asian Americans

Death and end-of-life matters are very very difficult to discuss within Asian cultures. According to one statistics, only 4% of Asian Americans have utilized hospice care. Yet this is such an important fact of life that all of us will eventually face with family and for ourselves. How to face this reality with grace and sensitivity? Here’s some helpful tips from Dr. DongMei Wang — via Hospice Matters: a Newsletter for Family and Friends of Hospice (Spring 2013) published by Montgomery Hospice in Montgomery County, Maryland ::

Hospice Discussions with Asian Patients by Dr. DongMei Wang

Montgomery County, Maryland is known for its rich and diverse culture and heritage. We have a large Asian community along with a growing Asian patient population. From nationwide data, we know that Asian patients use hospice care less often, as compared to other races. How can we help these patients in need to maximize their benefit from hospice?
Here are some thoughts based on my experience in my oncology private practice. Let’s first look at the barriers to utilization of hospice service by Asian patients:
  1. Many people from Asian cultures think death is a bad thing, and that anything linked to death is bad luck. They do not want to talk about death among family members.
  2. Respect for the elderly is an important part of many Asian cultures. As part of this respect, it is not uncommon for Asian adult children to hide a terminal illness diagnosis from their parents.
  3. Most Asian patients are not familiar with hospice care, as it is so rare in their country of origin.
  4. In general, Asian patients have less knowledge about the American medical system.
  5. Dying in a hospital is considered acceptable or the norm in Asian culture.
  6. Many Asians expect to receive medical treatment until they die. They may want to try anything and everything to help when there is a poor prognosis.
  7. Language barriers exist for many Asian patients and families.
When facing these challenges, here are some tips that I have found helpful when I talk to patients and families about hospice care:
  1. Do not rush. Set up a time and sit down with the patient and his or her family.
  2. Use an interpreter if you don’t speak their language.
  3. Get the family’s permission first before releasing a bad diagnosis to the patient.
  4. Emphasize quality of life rather than quantity of life.
  5. Learn about the family’s attitude towards hospice. Understand and respect a different culture’s approach towards end-of-life issues.
  6. Explain the benefit of pain control.
  7. Explain the benefit of getting service at home.
  8. Explain the benefit of stress relief for family members.
  9. Explain that the patient can keep his or her current doctor.
  10. Be open to alternative types of medicine.
I have been in a private oncology practice for 5 years, and face many of the same challenges every practitioner faces. I sincerely hope that my tips will help others to discuss hospice services with their patients.
Dr. DongMei Wang is Board Certified in Oncology and in Internal Medicine, and practices at Montgomery Oncology Care and Hematology in Rockville, MD
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One Comment

  1. This was a very good entry to read on, not to pick on race, but especially from someone who likely knows the general culture of most AAPI/Asian American and Pacific Islander demographics. Very few peer reviewed studies and journal articles are found exactly on Asians and their perceptions of death, and for some reasons even anthropological resources seem too watered down. Perhaps I didn’t do enough research and enough digging but I suppose when in doubt, use expert testimony as an example for suggestions.

    Thanks!

    Like

    Reply

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