Abstract
Use of hospice care in the United States grows every year, with 44.6% of deaths in 2011 involving hospice. Unfortunately, hospice is impacted by racial and ethnic disparities, such as underutilization by cultural minorities. One suggested reason for this disparity is the belief that hospice staff may be limited in their ability to competently care for patients from minority cultures. This study used a grounded theory methodology to explore narratives of hospice providers' encounters with culturally different patients and families. A theory, Prioritizing comfort, finding growth, was developed to describe the context of these encounters, the actions and interactions taken by providers, and the outcomes of those actions. This theory proposes that when cultural differences disrupt care, hospice providers act in ways to reduce risk to the patient and family's comfort. By focusing on risk management, these encounters had less than ideal outcomes for the providers. Some providers, though, took a more growth focused approach to their cross-cultural encounters by using techniques such as open communication and flexible accommodation. The proposed theory may provide hospice organizations a deeper understanding of barriers their providers may face in providing culturally competent care. Practical implications of the theory include suggestions to focus staff trainings on open communication, and encouraging a growth mindset by creating a safe environment for making mistakes.