Original Publication
Open Access

Culture & End-of-Life Care: An E-learning Course

Published: November 4, 2014 | 10.15766/mep_2374-8265.9958

Included in this publication:

  • Instructor's Guide.docx
  • Culture & End-Of-Life Module 1
  • Culture & End-Of-Life Module 2
  • Culture & End-Of-Life Module 3
  • Module Resource List.pdf

To view all publication components, extract (i.e., unzip) them from the downloaded .zip file.

Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.


Introduction: The climate is changing for end-of-life care. The NIH has sponsored major initiatives for research and education to "guarantee the quality of care provided to the dying individual and their surviving loved ones” (NIH State-of-the-Science Conference, 2004). Recent efforts aimed at improving care have emphasized the quality and depth of communication within the community of clinicians, patients, families and caregivers, improving prognostication and practitioner education, and building continuity of care through collaboration. Understanding patient and family perspectives on quality of life and satisfaction with care are critical to improving the quality of end-of-life care (NIH State-of-the-Science Conference, 2004). Methods: Culture & End-of-Life Care is a web-based course that integrates instruction in cultural issues and end-of-life care for primary care providers. The course employs 11 interactive case studies to teach a process-based approach to cross-cultural communication that does not rely on prior knowledge of the patient’s culture and discourages cultural stereotyping. The media-rich and highly interactive environment is designed to promote cognitive engagement and self-assessment. The 11 case studies can stand alone or be used as an integrated course. Results: In a randomized trial with practicing physicians, the course was enthusiastically received and associated with increases in knowledge and self-reported cultural competence skills at 9-week follow-up. It is an accepted and popular CME vehicle offered by the University of Arizona. The Phase I course has been adopted for training medical students at Tufts University. Discussion: Culture & End-of-Life Care fills a gap in training for cultural competence and end-of-life care.  

Educational Objectives

After completing the course, learners will be able to:

  1. Apply LEARN (listen, explain, acknowledge, recommend, negotiate) to incorporate culture in patient care.
  2. Adapt LEARN to reach agreements with patients and their loved ones on treatment plans that are respectful of their cultural and spiritual beliefs.
  3. Adapt LEARN to reach agreements with patients and their loved ones on treatment plans that are and inclusive of appropriate use of alternative treatments.
  4. Adapt LEARN to engage in difficult end-of-life discussions with patients and their loved ones.
  5. Collaborate across disciplines to provide end-of-life care.

Author Information

  • Eileen Van Schaik, PhD: Talaria, Inc.
  • Cynthia Roat, MPH: Seattle Children's Hospital
  • Laurie Fronek: Laurie Fronek - Writing and Editing Services

None to report.

This research was supported by the National Institute of Nursing Research (NINR) at the National Institutes of Health (NIH), # 2R44NR008839-03. 

Prior Presentations
Van Schaik, E. Culture & End of Life: an e-learning course. Presented at: The Palliative Medicine Conference at Harborview Medical Center; November 2010; Seattle WA.

Van Schaik, E. Evaluating the Effectiveness of Online Training in Culture and End-of-Life Care. Presented in the session, Illness and the Culture of Health, at the meeting of the Society for Applied Anthropology; April 2005; Santa Fe, NM.

This content is solely the content of the authors and does not necessarily represent the official views of NINR or NIH.


Van Schaik E, Roat C, Fronek L. Culture & end-of-life care: an e-learning course. MedEdPORTAL. 2014;10:9958. https://doi.org/10.15766/mep_2374-8265.9958