Cultural humility in hospice care

By Diane Deese, Vice President of Community Affairs, VITAS Healthcare

Cultural humility is a clinical skill that improves hospice care by shifting the focus from assumptions to active listening. For healthcare professionals serving diverse communities, it may be the single most important factor in building trust during end-of-life conversations.

South Florida is one of the most culturally diverse regions in the United States. In the Miami–Fort Lauderdale–West Palm Beach metro area, nearly half the population identifies as Hispanic, and more than half of residents in counties like Miami-Dade are foreign-born. Additionally, more than 75% of residents speak a language other than English at home — a reflection of continuous international migration that shapes how patients and families understand illness, approach treatment decisions and experience hospice care.

Every day, healthcare professionals care for patients whose distinct backgrounds, languages and beliefs influence what they want from end-of-life care. Yet despite best intentions, many difficult conversations still begin with assumptions.

What is cultural humility in hospice care?

Cultural humility in hospice care is the practice of approaching each patient as a unique individual rather than as a representative of a cultural group. It moves beyond static cultural competency training to foster ongoing curiosity, self-awareness and a genuine willingness to learn from each patient encounter.

Healthcare professionals may assume a patient understands their diagnosis the same way a clinician does. They may assume a family shares the same goals for care — or that they know what matters most based on a patient's age, race, ethnicity, religion or socioeconomic status. The reality is that every patient brings a unique perspective to the bedside, and no checklist can fully account for that.

Cultural humility vs. cultural competency: What's the difference?

Cultural competency refers to structured training that equips clinicians with knowledge about specific cultures. Cultural humility goes further. Where cultural competency asks, "What do I know about this culture?" cultural humility asks, "What can I learn from this individual?"

For decades, VITAS Healthcare, the nation's leading provider of end-of-life care, has emphasized cultural competency training for its clinical teams. While that foundation remains important, cultural humility represents the next step: acknowledging that no training program, textbook or checklist can fully prepare a clinician to understand every person's lived experience.

That distinction becomes critical when discussing serious illness, hospice eligibility or goals of care.

Questions that build trust during hospice conversations

When patients and families face difficult healthcare decisions, trust is the foundation of effective hospice care. Rather than making assumptions, healthcare professionals can open meaningful dialogue by asking:

• "What is most important to you as we discuss your care?"
• "Are there cultural, spiritual or family traditions we should understand?"
• "Who do you want involved in your healthcare decisions?"
• "What concerns you most about the future?"

These open-ended questions invite patients and their loved ones to share perspectives that might otherwise remain unspoken. The goal is not to become an expert in every culture — it is to better understand the person sitting in front of you.

Why listening matters more than having all the answers

One of the most common misconceptions among clinicians is that hospice conversations require having all the answers prepared in advance. More often, patients and families simply need someone willing to listen without judgment.

People express fear, uncertainty and hesitation differently. Some families prefer collective decision-making. Others rely heavily on faith leaders or extended family members. Some patients may avoid discussing death altogether because of deeply held cultural or personal beliefs.

These differences are not barriers to hospice care. They are opportunities to build understanding. When healthcare professionals approach conversations with humility rather than assumptions, patients are more likely to feel respected, heard and genuinely engaged in their own care.

Practical steps for healthcare teams

Cultural humility does not require a major organizational initiative. It can begin with small, intentional actions that any clinician can implement immediately:

• Replace assumptions with questions. Ask before concluding.
• Listen before offering solutions. Understand the patient's values before presenting options.
• Recognize personal biases and blind spots. Reflective practice strengthens clinical judgment.
• Create space for family and community influences. These often shape care preferences as much as medical information does.
• Focus on each patient's individual values and goals. Align care plans with what matters most to the patient, not what is most clinically convenient.

These practices improve communication, strengthen patient-clinician relationships, and help ensure that hospice care reflects what matters most to each patient and family.

A shared responsibility in healthcare

No matter a patient's background, one truth remains universal: people want to be treated with dignity and respect. Healthcare professionals have a unique opportunity — and responsibility — to create that experience by approaching every conversation with humility.

Cultural humility is not a soft skill. It is a clinical foundation for truly patient-centered hospice care. The most important question may not be whether a clinician understands someone's culture. It may be whether they have taken the time to understand the person.

Frequently asked questions

Q: How does cultural humility improve hospice care outcomes?

Cultural humility improves hospice care outcomes by ensuring that care plans reflect a patient's actual values, goals and preferences — rather than assumptions based on demographics. Patients who feel heard and respected are more likely to engage with care decisions, which supports better quality of life and family satisfaction.

Q: How can hospice teams support non-English-speaking patients?

Hospice teams serving diverse communities should ensure access to professional medical interpreters, translated care materials and staff trained in culturally sensitive communication. VITAS Healthcare serves patients across multilingual communities and provides resources to support care teams in these settings.

Q: What is the difference between cultural humility and cultural competency in a clinical context?

Cultural competency involves acquiring knowledge about specific cultural groups to inform care decisions. Cultural humility is an ongoing practice of self-reflection and curiosity that prioritizes learning from each individual patient. In hospice care, cultural humility is better suited to the complexity and intimacy of end-of-life conversations, where individual values often matter more than cultural generalizations.