Institution and Program Description

Metropolitan Jewish Health System is comprised of over 36 programs and services, including a Hospice Program and a Palliative Care Program. The Increasing Access to Palliative Care for the Orthodox Jewish Community program identified and addressed unmet needs unique to the Orthodox Jewish population around advanced illness and end-of-life situations.

Problem

Interactions between Orthodox Jewish patients at the end of life and medical practitioners are frequently difficult. Orthodox Jewish law places a great emphasis on extending life that can conflict with contemporary secular principles of palliative care and medical ethics, and this conflict is often exacerbated by a lack of communication and poorly informed decisions.

Processes to Resolve Problem

The program began with a comprehensive community-based research initiative that produced recommended practice changes for both rabbis and doctors, as well as educational materials for patients and family members. The program then disseminated these recommendations through community education; training for doctors, rabbis and other care providers; written materials; community organizing; and network building.

Outcomes

Over 1,200 laypeople attended community-wide educational presentations. Our Rabbi-Doctor training program is currently oversubscribed for multiple classes of 24 mid-career rabbis and doctors. Several hundred multimedia resource binders aimed at health care providers and caregivers have been distributed to every sizeable home care agency, hospice, and palliative care program in the New York metropolitan area.

Lessons Learned

Successful cultural competency programs are most effective when they originate inside the community and have the support of a h3 community network. Clergy and doctors do not inherently have a high level of trust in one another when it comes to medical decision-making at end of life, and they can benefit from training to communicate with each other more effectively.