Holistic models for end of life care: Establishing the place of culture

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Abstract
Introduction This article presents a holistic model for clinical palliative care and research which expands and improves previous models by fully recognizing the place of culture in illness. Methods Literature review and philosophical enquiry. Results Holistic models of patient care are essential to the practise of patient-centred care. However, these models have up to now largely neglected the role of culture and the search for meaning in the illness experience, despite evidence of disparities in the access of palliative care services by people from ethnic minority groups. A phenomenological approach to illness highlights three principles: that illness is cultural, that the search for meaning related to the finitude of human life is fundamental to the illness experience, and that illness narratives are culturally conditioned manifestations of the search for meaning in illness. A holistic model for palliative care is presented on the basis of these principles. Discussion A holistic model that recognizes the place of culture in illness has implications for clinical practice, service development, and training. We propose an agenda for research into cultural and spiritual aspects of care on the basis of the model, including the formulation and evaluation of service models that take into account cultural features of illness and meet patients’ needs for support with finding meaning

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