Ethical and cultural sensitivity in the palliative phase of heart failure: A scoping review

Background: Increasing migration is creating more multicultural and ethnically diverse societies, requiring healthcare professionals (HCPs) to address culturally determined values, preferences, and worldviews of patients and their families. Many patients with heart failure (HF) who require palliative care do not have their needs met within an equitable care pathway. This makes cultural sensitivity not only a practical necessity but also an ethical one.
Aim/Research question or hypothesis: The aim is to explore the experiences of HF patients and their family caregivers regarding ethical and cultural sensitivity, as well as the factors that underlie or influence these experiences.
Methods: A scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) guidelines. The PALETTE framework for performing a literature search in palliative care was used. Six databases, including PubMed, CINAHL and PsycINFO were searched for empirical studies published from 2020-2024. Eligible studies focused on (1) HF patients and their family caregivers, (2) experiences regarding ethics, cultural sensitivity and inclusiveness in HF care and (3) conducted in Europe. The findings were discussed within an international group of researchers, synthesised using a qualitative approach and reported according to the PRISMA-ScR framework.
Results: Findings on the ethical and cultural aspects of HF care include 1) ethical challenges in end-of-life decision-making processes, (2) communication about cultural and spiritual values, (3) inequalities in access to HF and palliative care, (4) ethnic, racial and gender related disparities, and (5) how socioeconomic factors shape HF patients’ approach to their illness.
Discussion: HCPs need to consider the unique cultural contexts of HF patients and their families to make ethical decisions that align with the patient’s values. Subgroups may encounter potential disadvantages based on ethnicity, race, gender or socioeconomic circumstances, such as unequal access to appropriate treatment options or palliative care. Communication about ethical and cultural values is crucial in reducing disparities and providing culturally sensitive care.