Many people find it difficult to communicate their expectations, fears, and beliefs as they cope with traumatic issues regarding end of life care. Whether you have a life-threatening condition or you have a loved one who is dying, you may feel that the healthcare and other service providers with whom you're involved are not understanding or respecting your concerns. If English is not your primary language or you have religious or cultural beliefs and traditions that are not well understood or accepted by the providers, you may feel even more isolated.

For these reasons, it is a good idea to begin conversations with your healthcare providers by helping them understand your beliefs and feelings about care at the end of life. This is the best way to ensure that your doctors can respect your wishes and help you make the decisions that are right for you and your family.

Cultural and religious traditions
Because each of us comes with our own religious, cultural, and family beliefs and practices, even a healthcare provider who is trying to give the best care possible may be unaware of conflicts with your traditions and beliefs. The provider may be creating problems without knowing why, so it is important to tell your doctor or other provider your expectations about treatment and care.

By saying, "in our culture, we usually care for our dying parents by…." and explaining your expectations, you open the door for the provider to gain a better understanding of how to be responsive to your concerns. If the provider is discussing treatments or options that you do not understand, ask him or her to explain it again in a different way.

You might also want to tell your provider something about the following issues:
	How do you and your family wish to make decisions about your care (for example, you alone, together as a family, the family making the decision on your behalf)?
	Whom would you like the provider to speak with about diagnoses, test results, and treatment options?
	Do you or your family have any fears about doctors or medical procedures or any experiences that may concern you?
	Does your family have any religious or cultural beliefs about medicine or medical procedures that you feel your provider may not know about?

If you continue to feel that communication with the provider is difficult, or that your wishes and beliefs are not being taken into consideration, find a supportive person to help in the discussion. Most hospitals and many other agencies have social workers who can act as patient advocates. Asking a clergy member or the hospital chaplain of your faith to join in the discussion may be another option.


Language Barriers
For health and supportive services, request that the services be provided in your primary language. Federal civil rights law requires agencies that receive public funding to provide interpreter services.

Many hospitals and other large agencies have staff fluent in the languages most commonly spoken in their communities or have on-call interpreters available as needed. If there is no interpreter available for a certain language, any health or supportive service agency should be able to provide telephone interpretation through a telephonic interpreter service.

Having a trained interpreter present when you speak with your provider can help prevent misunderstandings and confusion that can make a difficult process even harder. The interpreter can help make sure that you and the provider understand each other completely. A trained medical interpreter will not feel uncomfortable or embarrassed, as a family member might.

It is not appropriate for the agency to expect you to bring a friend or family member to interpret. While some patients may prefer that an English-speaking family member or friend also be present, you should always have the option to speak confidentially to your healthcare provider. In any case, it is preferable to avoid having a minor (under age 18) child interpret on behalf of a parent or other older relative.

For other information and resources:
	Office of Multicultural Health Department of Public Health 250 Washington Street Boston, MA 02108 Phone: 617-624-5270 FAX: 617-624-5046 website: www.mass.gov/dph/omh/omh.htm
	Multicultural Coalition on Aging 1200 Centre Street Boston, MA 02131 Contact: Marcie Freeman, M.Ed., Chair Phone: 617-636-8557 email: freeman@mail.hrca.harvard.edu website: www.hebrewrehab.org/professional/multicult.cfm The Multicultural Coalition on Aging is comprised of over 75 member agencies dedicated to improving the delivery of healthcare and social services to culturally diverse elders.
	Honoring Patient Preferences: A Guide to Complying with Multicultural Patient Requirements available online at: http://home.caregroup.org/honoring.pdf

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