title: Cultural and religious considerations in pediatric palliative care.
abstract: OBJECTIVE
  A growing multicultural society presents healthcare providers with a difficult task of providing appropriate care for individuals who have different life experiences, beliefs, value systems, religions, languages, and notions of healthcare. This is especially vital when end-of-life care is needed during childhood. There is a dearth of literature addressing cultural considerations in the pediatric palliative care field. As members of a specific culture often do not ascribe to the same religious traditions, the purpose of this article was to explore and review how culture and religion informs and shapes pediatric palliative care.
  
  
  METHODS
  Comprehensive literature searches were completed through an online search of nine databases for articles published between 1980 and 2011: PsychINFO, MEDLINE®, Journal of Citation Reports-Science Edition, Embase, Scopus, CINAHL®, Social Sciences Citation Index (SSCI), EBSCO, and Ovid. Key terms included: culture, transcultural, spiritual, international, ethnic, customs or religion AND end-of-life, palliative care, death, dying, cancer, or hospice, and children, pediatrics, or pediatric oncology. Reference lists in the retrieved articles were examined for additional studies that fit the inclusion criteria, and relevant articles were included for review. In addition, web-based searches of specific journals were conducted. These included, but were not limited to: Qualitative Health Research, Psycho-Oncology, Journal of Psychosocial Oncology, Journal of Pediatric Psychology, Journal of Pediatric Health Care, Journal of Pediatric Oncology Nursing, Omega, Social Work in Health Care, and Journal of Palliative Medicine.
  
  
  RESULTS
  Thirty-seven articles met eligibility criteria. From these, seven distinct themes emerged that have implications for pediatric palliative care. These include the role of culture in decision-making, faith and the involvement of clergy, communication (spoken and unspoken language), communicating to children about death (truth telling), the meaning of pain and suffering, the meaning of death and dying, and location of end-of-life care.
  
  
  CONCLUSIONS
  The review of the literature provides insight into the influence of religion and how culture informs lifestyle and shapes the experiences of illness, pain, and end-of-life care. Recommendations for providing culturally sensitive end-of-life care are offered through the framework outlined in the Initiative for Pediatric Palliative Care Quality Improvement Project of 2002. Cultural traditions are dynamic, never static, and cannot be generalized to all families. Guidelines to aid in approaches to palliative care are provided, and providers are encouraged to define these important differences for each family under their care.
authors.affiliation: National Cancer Institute, National Institutes of Health, Bethesda, MD, USA. wienerl@mail.nih.gov
authors.forename: Lori
authors.initials: L
authors.lastname: Wiener
authors.forename: Denice Grady
authors.initials: DG
authors.lastname: McConnell
authors.forename: Lauren
authors.initials: L
authors.lastname: Latella
authors.forename: Erica
authors.initials: E
authors.lastname: Ludi
mesh_terms: D001293:Attitude to Death / Q000208:ethnology*; D002648:Child; D002675:Child, Preschool; D018864:Cultural Diversity; D003657:Decision Making; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010166:Palliative Care; D010372:Pediatrics; D012068:Religion and Medicine; D029181:Spirituality; D013727:Terminal Care