Racial, Cultural, and Ethnic Factors Influencing

Past efforts in the palliative and end-of-life care field have been laudably directed at in-creasing the cultural competence of providers and institutions and improving outreach to mul-ticultural communities. Today, however, we face new challenges with regard to racial, cul-tural, and ethnic factors at the end of life. We now have documented evidence of disparities in almost every area of health care. In addition, breakthroughs in genomics research, includ-ing “race-based therapeutics, ” have redefined the meaning of our human differences. These trends, unfolding in an increasingly polarized post–9/11 world, greatly challenge our under-standing of concepts of race, culture, and ethnicity. By definition, when considering these concepts, our focus shifts from the individual to that of group membership. In turn, this suggests using a population-based or epidemiological ap-proach, which at once reveals inequalities and inequities in mortality patterns across diverse groups. Understanding and serving the needs of specific populations requires us to apply a framework of equity and to consider strategies to eliminate disparities. These include iden-tifying sources of bias and discrimination in health care; enhancing the collection of racial, ethnic, and other demographic data; and increasing the representation of a range of diverse population groups in well designed qualitative and quantitative research. Using an epi-demiological framework does not suggest, however, that we lose sight of dying individuals and their families. At the end of life, an individualized approach to care with a focus on qual-ity is paramount for any patient, regardless of racial, ethnic, or cultural background