Domain 6: Cultural Aspects of Care

An IDT should use a comprehensive care plan to develop culturally sensitive resources and strategies to meet patients’ and families’ needs.

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Recognizing barriers to culturally sensitive care, an IDT is expected to “practice cultural humility and celebrate diversity.” The IDT is expected to receive training in increase cross-cultural knowledge, empathy, and humility. Patients’ preferred language must be used and facilitated in all interactions. When required, medical interpreter services may be used, either in person or via telephone or video. A care plan that honors cultural practices is expected.

Domain 7: Care of the Patient Nearing the End of Life

This domain emphasizes care delivered on the days leading up to and just after the death of the patient. As patients approach death, a thorough implementation of all domains of care is critical to the patient and family.

Patients and families should be given appropriate education on what to expect as death appears imminent, as well as what to expect in the days following a patient’s death. They need to know that hospice care is an option, and should be informed on eligibility, benefits, and limitations of hospice care. Planning for post-death care (eg, funeral planning) and providing grief and bereavement support is an integral part of this domain of care.

During screening and assessment, the IDT reviews and confirms treatment decisions and, before a patient’s death, discusses autopsy, organ and tissue donation, and anatomical gifts, within organizational policies and laws.

Domain 8: Ethical and Legal Aspects of Care

Within this domain of care, an IDT honors patient preferences and decisions made by legal proxies or surrogate decision-makers. Knowing local and state laws benefits care planning, decisions on life-sustaining treatments, and treatments that may have legal implications, such as the use of medical marijuana to ease patient symptoms.

“The core principles of autonomy, substituted judgment, beneficence, justice, and nonmaleficence underpin the provision of palliative care,” the guideline committee authors wrote.

IDT members are expected to receive education in the fundamental ethical, legal, and regulatory principles that surround palliative care. Ethical consultants or an ethics committee may provide assistance in decision-making or to resolve conflicts. IDT protocols ensure patient and family access to ethics resources.

During screening and assessment, patients and families are provided information on living wills, as well as inpatient and out-of-hospital do-not-resuscitate orders. The IDT updates patient’s preferences, which may change over time.

Using the NCP Guidelines

The guidelines provide palliative care principles for clinicians to refer to when caring for seriously ill patients and their families. Specialist palliative care teams can use these doctrines to expand services to new patients, foster new partnerships, and improve care to patients and their families. The guidelines can be used to transform the care of patients and their families at existing practices, or in the design of new palliative care programs.

Wherever employed, the guidelines are intended “to help all clinicians and care settings improve access to all patients in need of palliative care, from the point of diagnosis throughout the illness or eventual death of the patient.”


  1. National Consensus Project for Quality Palliative Care. Clinical Practice Guidelines for Quality Palliative Care, 4th edition. Richmond, VA: National Coalition for Hospice and Palliative Care; 2018. Published October 2, 2018. Accessed October 29, 2018.