Cultural competence in end-of-life care: terms, definitions, and conceptual models from the British literature.
BACKGROUND
Cultural competency is increasingly recommended in policy and practice to improve end-of-life (EoL) care for minority ethnic groups in multicultural societies. It is imperative to critically analyze this approach to understand its underlying concepts.


OBJECTIVE
Our aim was to appraise cultural competency approaches described in the British literature on EoL care and minority ethnic groups.


METHODS
This is a critical review. Articles on cultural competency were identified from a systematic review of the literature on minority ethnic groups and EoL care in the United Kingdom. Terms, definitions, and conceptual models of cultural competency approaches were identified and situated according to purpose, components, and origin. Content analysis of definitions and models was carried out to identify key components.


RESULTS
One-hundred thirteen articles on minority ethnic groups and EoL care in the United Kingdom were identified. Over half (n=60) contained a term, definition, or model for cultural competency. In all, 17 terms, 17 definitions, and 8 models were identified. The most frequently used term was "culturally sensitive," though "cultural competence" was defined more often. Definitions contained one or more of the components: "cognitive," "implementation," or "outcome." Models were categorized for teaching or use in patient assessment. Approaches were predominantly of American origin.


CONCLUSIONS
The variety of terms, definitions, and models underpinning cultural competency approaches demonstrates a lack of conceptual clarity, and potentially complicates implementation. Further research is needed to compare the use of cultural competency approaches in diverse cultures and settings, and to assess the impact of such approaches on patient outcomes.
Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain. n.evans@vumc.nl
Natalie
N
Evans
Arantza
A
Meñaca
Jonathan
J
Koffman
Richard
R
Harding
Irene J
IJ
Higginson
Robert
R
Pool
Marjolein
M
Gysels
D054521:Cultural Competency; D006801:Humans; D008913:Minority Groups; D008962:Models, Theoretical; D013727:Terminal Care; D009626:Terminology as Topic; D006113:United Kingdom