1. End-of-Life
Renay Scales, Ph.D.

2. INTRODUCTION
Information comes from behavioral research about physicians and patients
Provides an opportunity to reinforce what you may have already experienced with your patients
Focuses on cultural belief systems of patients
Goal of increased success with patient outcomes

3. Clinical depression
Clinical anxiety disorders
Fluctuating states of psychosis or progressive disorders like dementia
Cultural or spiritual factors
Quality of life
Fear of loss of control and becoming a burden
Financial concerns

4. Discomfort communicating “bad news”
Discomfort with listening to patients and patients’ families
Lack of skills in negotiating goals for care, treatment, or futile therapies
Worries about lack of competence in working with patients or their families during this time
Understanding cultural, religious, and ethics differences related to end-of-life care and handling of death

5. 1. S—SETTING UP the Interview 2. P—Assess the patient’s PERCEPTION 3
1.S—SETTING UP the Interview 2. P—Assess the patient’s PERCEPTION 3. I—Obtaining the patient’s INVITATION 4. K- Giving KNOWLEDGE and information to the patient 5. E-Addressing the patient’s EMOTIONS with empathetic responses S-Strategy and summary (SPIKES Step 6 Protocol)

6. Jewish Patients
Muslim Patients
Sikh Patients
Gypsy Patients
Hindu Patients
Buddhist Patients
Atheist Patients

7. jewS
May only eat Kosher, and food should be opened in the presence of the patient
Routine autopsies are not permitted, and withholding or removing medical support or nutrition should be approved by the patient and/or family’s Rabbi.
May request provider who is the same sex/gender.
After death the body should not be left along and any areas likely to leak bodily fluids should be bandaged or those fluids buried with the body. Even blood remaining in the tubes should be buried.
Special attention should be given to holy days. (Sabbath,Yom Kippur…)
Eyes should be closed at the time of death and sheet placed over the body, and attendants go with the body to the morgue
Organ transplant possible after full brain death

8. MUSLIMS Dietary considerations Scheduling regarding Ramadan
Autopsy not encouraged
Growing and shrouding the body
Modesty: Same sex physician and respecting privacy
Prayer arrangements

9. SIKHS 5 K’s - (Kesh, Kangha, Kara, Kirpean and Kachhehra)
Uncut hair (gift from God)
A wooden comb (cleanliness)
A steel bracelet (self-restraint; link to God)
A short sword (courage and commitment to truth and justice)
Knickers (reps purity of moral character)

10. (SIKH cont’d) Healthcare Expectations:
Respect the patient’s personal space by limiting unnecessary touching
Do not interrupt prayer for routine care
If headdress has to be removed, keep the head covered with a bouffant cap
Respect headdress by placing in a clean place (not with shoes that have been on the floor, etc.)
Consult about any hair removal
Cleansing of the body
…and may require physicians who are the same sex on the patient

11. GYPSIES AND TRAVELLERS
A key issue is trust in physicians; western medicine so the manifestation is a larger group of members in the patient’s room than is normally allowed.
The size is also about how members travel.
Self-reliance and control; low expectations of health; stoicism

12. HINDUS Many Hindus are strict vegetarians.
Believe the body is a vehicle for the soul through which it can experience the world and journey to God. When its purpose is served, the soul takes on another body until it finds union with God.
Extended family members tend to have role in patient’s healthcare
Comfort with natural death so no prolonged life support
Prefer cremation within 24 hours of death. Death certificate completion will need to occur quickly.
Some Hindus may be against circumcision.

13. BUDDHIST 250 MILLION IN THE U.S. 3 SECTS OR BRANCHES
Some practitioners will not be agreeable with organ donations given the belief that to do so may effect the consciousness of the decedent.
Priest’s role is to assist patient with decision-making
A request for simple alter may be patient’s request with understanding about prohibition of lighting candles.

14. Atheists
There are no state or federal laws or regulations that require health care providers to inform patients of services or treatments a provider will not provide because of the provider’s religious beliefs. Religious hospitals account for more than 17 percent of all hospital beds in the United States, and religiously based hospitals, physicians, and other health care entities treat more than 1 in 6 Americans each year.

15. Maybe the pieces of the puzzle come a little closer
together

16. REFERENCES
Cleemput, P. et al, “Health-related beliefs and experiences of Gypsies
and Travellers: A qualitative study.” Journal of Epidemiology and
Community Health, 10 (1136). BMJ.
Conway, J. and Howard, V., Bluegrass Care Navigators “Current issues in medicine” lecture, Difficult Discussions at the End-of-Life. KYCOM.
patients-in-americas-religious-health-care-system/
Metropolitan Chicago Healthcare Council and Council for a Parliament of
the World’s Religions (CWPR), “Quick reference for health care
providers interacting with patients and their families.”