Strategies to Engage Diverse Population in Home-Based Palliative Care: A Qualitative Study in Hawaii.

Abstract

Several studies have documented racial and cultural inequities in the receipt of palliative care. With expanding home-based palliative care programs spreading across the United States and in other countries, understanding barriers to enrollment of diverse populations and promising practices to overcome these barriers is critical. To identify barriers to enrolling diverse patients in home-based palliative care, and to elicit successful strategies and best practices in engaging and communicating with diverse populations about palliative care. We conducted a qualitative study employing nine focus groups with staff from nine home-based palliative care agencies in Hawaii. Interviews were conducted via video conferencing and audio recorded. Using thematic analysis, we identified core themes related to challenges and best practices of engaging minorities in palliative care services. Barriers to care acceptance included perceptions of "giving up," lack of knowledge of palliative care, cultural values and attitudes, language barriers, and issues of healthcare accessibility and equity. In response, we identified facilitators and recommendations to care which highlighted the importance of community leader involvement, respect for patient and family-centered care, building trust and ensuring continuity in care, having staff and materials in diverse languages, in-person conversation about palliative care services, and the active engagement of family in healthcare decision-making. These findings highlight the importance of considering cultural factors in the provision of care and underscore the necessity for culturally sensitive, patient-centered approaches to hospice and palliative care.