title: A call to improve practice concerning cultural sensitivity in advance directives: a review of the literature.
abstract: BACKGROUND
  The Patient Self Determination Act of 1990 mandates healthcare providers (HCP) to speak with patients about end-of-life preferences and advance directives (AD). HCP work with patients of varying cultures, and standard ADs do not address cultural differences. In order to understand various cultural beliefs, cultural sensitivity is important especially when discussing advance care planning (ACP).
  
  
  OBJECTIVE
  Individuals from differing ethnic backgrounds are likely to turn to their traditional norms of practice when ill or treatment choices must be made. An AD that addresses varying cultural values and beliefs was sought.
  
  
  METHODS
  A comprehensive review of the literature was conducted. Articles selected for review included qualitative and quantitative studies. The evidence was evaluated and synthesized for information related to cultural sensitivity and ADs.
  
  
  RESULTS
  Three common themes emerged related to ACP discussions and culture. Healthcare provider awareness, communication, and education concerning cultural differences and ACP assisted in meeting the needs for end-of-life planning in the current era of increased globalization. Education for HCP on cultural differences and how to lead discussions promoted ACP.
  
  
  CONCLUSIONS
  ADs are an essential part of health care and promote patient-centered care. (HCP) should be able to recognize differing cultural values and beliefs in order to initiate conversations about end of life. Initiating conversations about ACP can be facilitated by using open-ended questions that respect the values and beliefs of various cultures.
authors.affiliation: Northern Arizona Veterans Administration Health Care System, Geriatric Extended Care, Prescott, AZ 86313, USA. bzager@asu.edu
authors.forename: B Sue
authors.initials: BS
authors.lastname: Zager
authors.forename: Margaret
authors.initials: M
authors.lastname: Yancy
mesh_terms: D024362:Advance Directive Adherence / Q000331:legislation & jurisprudence / Q000592:standards*; D003469:Culture; D006801:Humans; D016224:Living Wills / Q000208:ethnology*; D013727:Terminal Care / Q000331:legislation & jurisprudence / Q000592:standards*; D016746:Transcultural Nursing / Q000592:standards*; D014481:United States