Past efforts in the palliative and end-of-life care field have been laudably directed at increasing
the cultural competence of providers and institutions and improving outreach to multicultural
communities. Today, however, we face new challenges with regard to racial, cultural,
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, including
"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 understanding
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 approach,
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 identifying
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 epidemiological
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 quality
is paramount for any patient, regardless of racial, ethnic, or cultural background.
