Session: It’s All in the Presentation: Attention to Culture, Practice, and Policy in Preparation for Decisions about End-of-Life Care (Society for Social Work and Research 15th Annual Conference: Emerging Horizons for Social Work Research)

High quality end-of-life care is best achieved when health care professionals treat a dying person with respect, enhance desired physical comfort and emotional support, communicate needed information, promote shared decision making, and coordinate care across settings. Good communication is a necessary component of medical care that achieves individuals' and families' goals, consistent with their conceptualizations of quality of life and cultural values (Teno, et al., 2004). The three studies presented in this symposium address how the presentation of end-of-life care options may influence decision making among potentially vulnerable and culturally diverse populations. The first study addressed the documented disparities in and barriers to hospice use among African Americans (NHPCO, 2009). Primary among these barriers is lack of exposure to information about hospice (Johnson, Kuchibhatla, & Tulsky, 2009). A brochure using role model stories of African Americans who had used hospice services was developed and presented to older African Americans with chronic illness. Pre- and post- measures were taken and after reading the brochure these individuals had more positive attitudes toward hospice and reported a greater likelihood to enroll in hospice. The second study also examined knowledge and end-of-life care decisions among Latino older adults; another group for which disparities in access to end-of-life care has also been well-documented (NHPCO, 2009). The results of a specific survey designed to be culturally- appropriate for Mexican Americans about attitudes toward resuscitation and life-support directives pointed to the importance of how the options were presented in hypothetical case scenarios. Social workers can work to ensure that options are presented in conjunction with health providers in a manner that is understandable and culturally appropriate. The third study examined social work involvement in how information about Oregon's Death with Dignity (DWD) Act and the option of physician-assisted death are accessed. A survey of Oregon's hospice social workers found that social workers were highly engaged in specific discussions and decision making about the option of assisted death. While general information about the DWD Act may be available, the intricacies about choosing the option and what it means for individuals and families often require in-depth discussion and consideration. As more states consider and ultimately adopt the option of physician-assisted death, understanding the social work role in relation to how the information is presented and decisions can be facilitated will become increasingly important. All three studies have implications across levels, from micros to macro, of social work practice with those facing decisions at the end of life. Seriously and terminally ill individuals must have access to information about all options available in various formats so that myths may be dispelled and informed decisions leading to improved quality at the end of life are possible. In an ever-changing health care environment, attention to the interface with increasing older, culturally diverse populations takes on critical importance. Social workers are uniquely suited to facilitate translation of effective end-of-life care interventions and advocate for policy changes needed to enhance decision making and care at the end of life.