Cross-cultural differences in hospices. A retrospective study in Italy

Aim: Increasing immigration in Italy poses challenges in providing cross-cultural palliative care (PC) and end-of-life (EOL) care. In this retrospective study we report the difficulties encountered by hospice operators caring for immigrant patients admitted to 16 hospices in Emilia Romagna from 2001 to 2011. Materials and methods: 327 immigrants were admitted in the study period (1.6% of total admissions). 379 hospice operators were surveyed regarding their experiences in cross-cultural encounters through a questionnaire. Answers were evaluated by the Mann-Whitney U test and chi-square test. 252 operators responded to the questionnaire (67% of total). Results: Relational aspects were the most frequent difficulties experienced by nurses during patient admission and hospitalization and by physicians during EOL. Language difficulties were reported by 75% of responders, regardless of their profession. Difficulties directly correlated with years of experience in a hospice (p=0.002). Conclusions: The results of this study suggest that hospice operators should learn how to deliver quality cross-cultural care. The problems encountered by both Italian doctors and nurses were most likely due to lack of teaching and training in cross-cultural communication and cultural competence. Immigrant patients admitted to Italian hospices are still few, but their number is expected to increase. Appropriate cross-cultural education should become mandatory for medical and nursing students as well as oncology and PC operators.