Culturally and Linguistically Diverse (CALD) communities

Culturally and Linguistically Diverse (CALD) Communities

Culturally appropriate palliative care respects and supports individual cultural, linguistic and spiritual needs and preferences. Responding to individual needs is an important part of providing person-centred palliative care for our ethnically diverse population.

For people accessing Australian hospital palliative care services in the period July to December 2018, Palliative Care Outcomes Collaboration (PCOC) data shows that 83% were born in one of 15 countries. [1] Places of birth included: Australia (60.6%), England (7.1%), Italy (4.0%), Greece (2.2%), New Zealand (2.0%), Scotland (1.2%), Germany (1.1%), and China (1.1%).

Being able to communicate with patients and their families is also recognised as an essential component of quality palliative care. The most commonly preferred languages among these patients were English (88.4%) followed by Italian (1.9%), Greek (1.5%), Chinese (1.2%), Arabic (0.9%) and Macedonian/Croatian (0.8%). In all 15 specific languages were listed by 97% of all palliative care patients in this period.

The data from PCOC reflects our ageing population, with people aged 65 years or older accounting for 3 in 4 episodes of hospital based palliative care in this period. This explains why the list of preferred languages for people accessing these services in 2018 differs to that of the general population. The top four languages spoken at home for the general Australian population (all adults) in 2017 were English, Mandarin, Arabic, Cantonese, and Vietnamese. [2] However, in 2016 the most commonly spoken non-English languages for people aged 65 and over were Italian (3%), and Greek (2%). [3]

These findings support the need for broad cultural awareness and linguistic skills among providers of care. The following resources may be useful in planning for and providing culturally appropriate care.

Practice Issues

Action plan for older people from Culturally and Linguistically Diverse Backgrounds 2019 (Current freely available)
This guide presents actions to address specific barriers and challenges faced by this group. It includes case studies, links to existing resources, and a separate consumer-focused document.

Centre for Cultural Diversity in Ageing Resources and culturally inclusive aged care practice guides. Current (freely accessible online resource)
Practice guides covering a wide range of topics including palliative care and spiritual support.

Advance care planning in culturally and linguistically diverse (CALD) populations
Advance Care Planning Australia has fact sheets and other resources available for individuals, substitute decision-makers and aged care workers in 13 languages.

Clark K, Phillips J. End-of-life care - the importance of culture and ethnicity (495kb pdf). Aust Fam Physician. 2010 Apr;39(4):210-3. (freely accessible)
Australia is a culturally and ethnically diverse country. Within such diversity there will be differing beliefs systems about death and dying. This may be a challenging prospect for health professionals. This article discusses how cultural diversity may impact care and provides some strategies for the general practitioner when considering the provision of end-of-life care.

Federation of Ethnic Communities’ Councils of Australia (FECCA) Review of Australian Research on Older People from Culturally and Linguistically Diverse Backgrounds (2.7MB pdf). March 2015 (freely accessible)
Federation of Ethnic Communities’ Councils of Australia (FECCA) commissioned the Australian Population and Migration Research Centre, University of Adelaide, to review the Australian research on older people from CALD backgrounds. The aims of the review were to identify the existing research evidence base about older CALD Australians and to identify gaps in the research, covering four broad topic areas:  Key findings from the report includes identication of research gaps in the evidence base, the needs and roles of CALD carers and carers of older people from CALD backgrounds in RAC, the increased risks around mental health issues in older people from CALD backgrounds and research outcomes in the area of dementia in older CALD populations.

  • older people from CALD backgrounds in general;
  • older people from CALD backgrounds with dementia;
  • ageing and mental health issues for people from CALD backgrounds; and
  • CALD carers and carers of older people from CALD backgrounds.

Johnstone MJ. Bioethics, cultural differences and the problem of moral disagreements in end-of-life care: a terror management theory. J Med Philos. 2012 Apr;37(2):181-200.
Explores cultural differences and how health care providers can reduce the impact of harmful moral outcomes in end-of-life care.

Komalasari R, Chang HCR, Traynor V. A review of the Rowland Universal Dementia Assessment Scale. Dementia (London). 2019 Jan 3:1471301218820228.
The aim of this systematic literature review was to examine use and reliability of the Rowland Universal Dementia Assessment Scale (RUDAS) tool when adapted for use among older people residing outside of Australia. RUDAS was originally developed in Australia for dementia assessment in culturally and linguistically diverse communities, and this review provides important insights into extended application and tool validity.

Petrov L, Joyce C, Gucciardo-Masci T. Aging in Australia: country of birth and language preferences of residents in aged care facilities. Aust Health Rev. 2017 Sep 5. doi: 10.1071/AH17032.
Provides detailed, service- and policy-relevant information on the multicultural and language diversity of people living in RACFs in Victoria.

Policy and management considerations

Australian Government Department of Health. National ageing and aged care strategy for people from Culturally and Linguistically Diverse (CALD) backgrounds (806kb pdf). 2012. (freely accessible)
The strategy is designed to inform the way the Australian Government supports the aged care sector to deliver care that is appropriate and sensitive to the needs of older people from CALD backgrounds. The strategy will assist the Department of Health in implementing the activities outlined in the Living Longer Living Better aged care reform package and assist in guiding future funding priorities. It is essential for aged care services to support the lives of older people from CALD backgrounds, their families and carers to continue to contribute to and engage with their communities. Priorities outlined include:

  • CALD input positively affects the development of ageing and aged care policies and programs that are appropriate and responsive
  • achieve a level of knowledge, systems capacity and confidence for older people from CALD backgrounds, their families and carers to exercise informed choice in aged care
  • older people from CALD backgrounds are able and have the confidence to access and use the full range of ageing and aged care services
  • monitor and evaluate the delivery of ageing and aged care services to ensure that they meet the care needs of older people from CALD backgrounds, their families and carers
  • enhance the CALD sector’s capacity to provide ageing and aged care services
  • achieve better practice through improving research and data collection mechanisms that are inclusive of cultural and linguistic diversity in the ageing population

Johnstone MJ, Kanitsaki O. Ethics and advance care planning in a culturally diverse society. J Transcult Nurs. 2009 Oct;20(4):405-16.
Emerging international research suggests that in multicultural countries, such as Australia and the United States, there are significant disparities in end-of-life care planning and decision making by people of minority ethnic backgrounds compared with members of mainstream English-speaking background populations. Despite a growing interest in the profound influence of culture and ethnicity on patient choices in end-of-life care, and the limited uptake of advance care plans and advance directives by ethnic minority groups in mainstream health care contexts, there has been curiously little attention given to cross-cultural considerations in advance care planning and end-of-life care. Also overlooked are the possible implications of cross-cultural considerations for nurses, policy makers, and others at the forefront of planning and providing end-of-life care to people of diverse cultural and language backgrounds.

Associated materials

CareSearch. Multicultural - Cultural and linguistic diversity (Non-English speaking background). Current (freely accessible website)
Overview of issues in relation to palliative care for culturally diverse and non-English speaking populations. Includes links to further information, consumer resources and one-click topic searching of evidence through to PubMed database.

ELDAC Project Australia’s ageing Culturally and Linguistically Diverse population. Current (freely accessible website)
This page identifies a range of issues influencing cultural diversity and intersectionality.

Palliative Care Australia Multilingual resources. Current (freely accessible resource)
Multiple consumer resources produced in 12 languages. Topics include:

  • what is palliative care?
  • facts about morphine
  • asking questions can help
  • about Pain and Pain Management
  • about the Dying Process
  • What Can I Say? What Can I Do? When Someone I Know Is Living With A Terminal Condition

Palliative Care Curriculum for Undergraduates (PCC4U). Culture-centred care of people with life-limiting conditions. Current (freely accessible website)
Online learning modules for health professionals providing information about provision of appropriate palliative care to that responds to the specific needs of people with life-limiting conditions, it is important to recognise cultural considerations associated with end-of-life and bereavement.

Palliative Care Victoria Culturally and linguistically diverse people. Current (freely accessible website)
Website provides information to promote access to culturally inclusive and responsive palliative care services for people from diverse cultural, linguistic and faith backgrounds. Topics include CALD communication and language services, CALD community profiles, cultural and spiritual diversity, cultural responsiveness resources, information in community languages, palliative care cultural responsiveness strategy and videos in community languages.

Migrant Information Centre, Eastern Melbourne. Palliative care for culturally & linguistically diverse communities: cultural profiles to assist in providing culturally sensitive palliative care (1.2MB pdf). 2009. (freely accessible)
This resource has been developed to help palliative care providers care for people from CALD backgrounds and to build sensitivity to basic cultural differences. The resource considers the social, emotional, physical and spiritual needs of the person who is using palliative care services and their families. It will support staff to develop strategies to provide culturally appropriate services specifically for Cambodian, Chinese, Indian, Iranian, Sri Lankan and Vietnamese communities.

Page updated 09 October 2019

  • References

  1. Connolly A, Burns S, Allingham S, Foskett L, Clapham S. Patient outcomes in Palliative Care: National report July to December 2018. (1.60MB pdf) Wollongong: PCOC, Australian Health Services Research Institute, University of Wollongong; 2019 Apr.
  2. Australian Institute of Health and Welfare (AIHW). Paliative care outcomes 2017 [Internet]. 2019 [updated 2019 May 22; cited 2019 July 26].
  3. Australian Institute of Health and Welfare (AIHW). Older Australia at a Glance [Internet]. 2018 [updated 2018 Sep 10; cited 2019 Apr 17]; AIHW cat. no. AGE 87.