Pain Reporter: Practitioner Cultural Awareness Can Lead to Better End of Life Pain Management for South Asians

A recent Daily Dose brought to our attention a study about the disconnect between healthcare providers and South Asian patients receiving end of life care. It highlighted the need for more culture awareness. We spoke to Nidhi Khosla, PhD, MPH, the lead author of the study. She is an Assistant Professor in the Department of Health Sciences at the School of Health Professionals of the University of Missouri, Columbia.

Q: What steered you and your team to this research?

NK: Despite a sizeable population of over 3.8 million South Asians living in the US, there has been limited research on their palliative care preferences. As a result, healthcare providers do not have sufficient information to provide culturally sensitive care to this population, leading to the potential for inappropriate care. Our team seeks to address this lacuna and contribute to culturally sensitive care for South Asians.

Q: Were the older South Asians studied born in the United States? Was there a difference in first generation vs second generation patients?

NK: Our study focused on the perspectives of healthcare providers' experiences of caring for South Asian patients; they did not identify differences by first vs second generation. As per census data, however, most older South Asians were born outside the US, so it is likely many of the patients referenced were first generation. We did not interview patients. Investigating patients' perspectives is the subsequent stage in our research.

Q: End of life care is difficult for most patients. Please explain the greater difficulty with South Asian patients.

NK: South Asians may be reluctant to discuss or plan for end of life due to reasons such as cultural taboos, the expectation that family will make end of life care decisions, beliefs such as karma that can be interpreted as events being destined and not amenable to planning (eg, circumstances around one’s death), and the preference to be conscious and not sedated at the time of death. South Asian beliefs are very diverse and there may be more beliefs than stated above. Further, as is true in every culture, not all beliefs are subscribed to by all members of a culture. Therefore, not all South Asians may hold the above-mentioned beliefs.

Q: Do you foresee a time when medical students will routinely be taught how to communicate with those of other backgrounds?

NK: There is already recognition of the need to foster cultural competence among the medical profession. Over time, the medical curricula will need to include even greater content on intercultural communication and cultural competence. The purpose of this study was to provide an evidence-base to help guide the development of knowledge useful for medical professionals.

Q: Do you plan to study larger numbers of patients? Or other nationalities?

NK: I do plan to recruit patients in future studies. I am interested in several minority groups from Asia and the Middle East.

Q: What do you think about the current state of pain management in the United States ?

NK: In the US, previous research has documented ethnic disparities in access to pain medication such as reduced availability in nonwhite neighborhoods. There is a pressing need to improve our knowledge about factors that contribute to these disparities and how cultural values may influence individual preferences.

Q: When you’re not working, how do you like to spend your time?

NK: I like cooking dishes of different cuisines; yoga; and ballroom dancing.

Q: What is a dream project on which you hope to work?

NK: I would love to do comparative studies on palliative care preferences among US South Asians and those living in South Asia. I am also interested in comparing palliative care preferences and access among different US minorities. The findings would then be disseminated through policy briefs and journal articles so that access to palliative care can be improved.

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