University-Community-Hospice Partnership to Address Organizational Barriers to Cultural Competence in Hospice

Background and Purpose: Research documents a lack of access to, utilization of, and satisfaction with hospice care for African Americans. Models for culturally competent hospice services have been developed, but are not in general use. Major organizational barriers include lack of funding for culturally competent services, lack of applications from African American professionals, an organizational culture that creates barriers to access, and lack of awareness of which cultural groups are not being served. A participatory action research project addressed these organizational barriers through a multicultural social work student field placement in one rural hospice. The effectiveness of the student interventions was evaluated, including addressing organizational barriers, cultural competence training of staff, and community outreach.

Methods: This participatory action research project used mixed methods, including 1) a single system design to document changes in agency outcomes in one hospice, 2) a non-experimental design to document the effectiveness of a staff cultural competence training session and three public information sessions, and 3) qualitative interviewing with staff, community leaders, and students to understand the cultural competence of the hospice and the impact of the project. All staff were invited to complete pre- and post-tests evaluating 1) organizational barriers at the beginning and end of the project (n=9), and 2) cultural competence training (n = 32). All members of the audiences at three public information sessions were invited to complete pre- and post-tests evaluating the effectiveness of the presentations (n = 21). Organizational barriers were measured through revised versions of the Access and Diversity Survey and the Self-Assessment Checklist for Personnel Providing Primary Health Care Services. Qualitative questions were also included to assess changes in organizational barriers. A revised version of The Hospice Barriers Scale was used to evaluate the public information sessions. Data analysis consisted of paired samples t-tests to document changes from pre-test to post-test in staff assessment of organizational barriers, staff scores for cultural competence training, and community member scores for the public information sessions. The grounded theory approach was used for analysis of the qualitative interview questions.

Results: Analysis revealed significant differences (p < .05) between pre-tests and post-tests in organizational barriers, staff cultural competence, and knowledge and attitudes toward hospice of community members. Qualitative results documented successes as well as lessons learned through the project.  In addition, the number of African American patients and volunteers increased in the hospice from the beginning of the project to the end.

Conclusions and Implications: This study provides evidence that a social work student field placement can address organizational barriers to culturally competent services in hospice. This is a practical strategy that could improve practice in the field, including in rural areas, and assist hospices in compliance with the new Centers for Medicare & Medicaid Services (CMS) requirement to demonstrate attempts toward cultural competence. This study is limited by its small sample and intervention in just one hospice; further research is needed to further document the role of social workers in development of cultural competence in hospice.