Cultural Humility in Caring for People with Serious Illness
Although palliative care is grounded in health equity core tenets (because the goal is to maximize quality of life for people living with serious illness, regardless of age, stage of illness, gender, race, ethnicity, etc.) providers must still engage in self-assessments and be grounded in cultural humility. Specifically, Domains 6 and 8 of the National Consensus Project (NCP) Clinical Practice Guidelines for Quality Palliative Care, 4th Edition, highlights palliative care’s responsibility to address cultural aspects of care as part of providing high-quality patient-centered care.
Palliative care teams must: 1) ensure equitable, culturally humble care in patient and family interactions; and 2) identify opportunities to address the larger forces, structures, and systems that contribute to health and health care inequities.
What is Cultural Humility?
Cultural humility1 is the ability to see and authentically accept another who is different from oneself. Acceptance of differences that may include race and ethnicity, gender identity, national origin, religion, sexual orientation, neurodiversity, how one physically, emotionally, and spiritually navigates the world, and so many more variables.
Different core beliefs are more likely to lead to false assumptions, broad generalizations, misunderstanding, and poor communication.2 Cultural humility allows one to remain open to these differences despite ingrained societal influences that may implicitly or explicitly encourage otherwise. Cultural humility is how one responds to these differences, with openness, humility, and awareness or at minimum, an understanding that biases exist in each of us. Acting with cultural humility and responsiveness means one has an awareness that one is never truly a cultural “expert”. Remaining culturally humble and responsive requires continuous growth and learning.
Cultural Humility Attributes
- Acknowledges power imbalance
- Be willing to say when you don't know
- Align your accumulation of knowledge with broadening behavior and attitude
- Give up the role of expert; embrace role of student of patient
- Build trust as you develop a care plan2
Cultural Humility (HUMBLE) Model
- Humble about the assumptions you make
- Understand your own background and culture
- Motivate yourself to learn more about the patients background
- Begin to incorporate this knowledge into your care
- Life-long learning
- Emphasize respect and negotiate treatment plans2
Cultural humility is the vehicle that can get you to individuation (defined as focusing on specific information about each individual to inform decision-making).
Cultural humility will help me understand you, individuation helps me understand the “you” that is making the decision at the time.
Adopted from ©Moore Genesis Consulting Services, 2021
Adopted from Regence, Navigating Cultural Differences: Palliative Medicine Provider Education Workshop, 2016