The Albert Einstein Healthcare Network in Philadelphia serves ethnically diverse communities; its Community Ethics Program was started to engage members of these groups in discussions about quality care at the end of life and to learn about their views on issues such as the use of specific life support measures, advance care planning, and appropriate care. The program seeks to apply findings to promote culturally responsive healthcare policies and practices, especially around care at the end of life. With funding by The Nathan Cummings Foundation and The Albert Einstein Society, The Community Ethics Program has forged on-going relationships with many communities in the Einstein service area. One phase of the program’s work focused on the Korean-American community.
Our methods included interviews with Korean-American physicians, representatives of social service organizations, officers of associations for the elderly, and members of the clergy. These meetings helped to identify pertinent issues and concerns, while identifying other Korean organizations. Census data, hospital records, and demographic data were also used to understand morbidity and mortality data as it pertained to this population.
We organized and conducted a Korean Community Leaders Forum that included representatives from the area’s major social, medical and religious groups; leaders of local government health departments; and hospital directors of services such as hospice and geriatric services. As part of the Forum, participants discussed the health needs and priorities of the Korean community, focusing on the elderly and terminally ill. We also reviewed and discussed advance care documents, e.g., living wills and the more extensive "Five Wishes" document, which we had translated into Korean. Priorities to promote quality of care, particularly for patients and families dealing with terminal illness, were identified and tested for validity one month later in focus groups.
The priorities and issues identified through our work to date include the following:
Focus group members and community leaders were receptive to the use of advance care documents, though expressed lack of familiarity with the documents. In general, participants felt that Korean-Americans would not pursue futile, life-prolonging measures; however, parents and adult children do not openly discuss the issue.
Because death remains a taboo topic, any discussion around care at the end of life will require culturally sensitive approaches. Participants felt that patients and families need to complete advance care documents together so that decisions are informed by family discussion and acknowledged by all. This would allow the family to honor the document later while still honoring the traditional value of hyodo, or filial piety
As a result of our initial efforts with the Korean community in Philadelphia, we learned that our translated advance care documents have found their way into social groups, churches, and physicians’ offices. We have received additional requests to develop educational sessions with organizations serving this community and to collaborate on programs addressing the needs of terminally ill patients and their families. The Community Ethics Program continues to work with this community and others in our service areas to identify community standards and priorities for quality care at the end of life and to promote collaboration between our hospital system and the communities we serve.
For more information, contact
Tina Phipps, Ph.D.
Director, Ethics & Health Policy Initiatives
Albert Einstein Healthcare Network
Germantown Community Health Services
1 Penn Boulevard
Philadelphia, PA 19144
215.951.8137
phippst@aehn2.einstein.edu
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