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From: Cultural Relevance in End-of-Life Care

http://ethnomed.org/clinical/end-of-life/cultural-relevance-in-end-of-life-care 1

Kagawa-Singer & Blackhall’s ABCD Cultural Assessment Model

Kagawa-Singer and Blackhall developed a cultural assessment mnemonic approach to assess the degree of cultural adherence to help avoid stereotyping and decrease the risk of miscommunication (Kagawa-Singer & Backhall, 2001). The ABCD cultural assessment is outlined below:

Relevant Information Questions and Strategies for the Health Care


Attitudes of parents and families: • What attitudes does this ethnic /cultural

group in general – and the patient and family in particular – have about truth telling with regard to diagnosis and prognosis?

• What is their general attitude towards discussion of death and dying?

• Do they have positive or negative attitudes about particular aspects of care?

• Increase one’s knowledge about the values, beliefs, and attitudes of the cultural group most frequently seen in your practice.

• Determine the patient and family’s perception of an illness: “What does your illness/sickness mean to you?”

• Determine if the patient uses traditional healing practices and for what problems.

• Determine if the patient or family has positive or negative attitudes about a particular aspect of care being addressed, such as advance directives.

Beliefs: • What are the patient’s and family’s

religious and spiritual beliefs, especially relating to the meaning of death and dying, the afterlife, and miracles?

• “Spiritual or religious strength sustain many people in times of distress. What is

important for me to know about your faith

or spiritual needs?”

• “How can we support your needs and practices?”

• “Where do you find your strength to make sense of what is happening to you?”

Context: • Determine the historical and political

context of the patient’s and family’s lives, including place of birth, refugee or immigrant status, poverty, experience with discrimination, health disparities, language spoken, and degree of integration within their ethnic community and the degree of assimilation into Western culture.

• “Where were you born and raised?” • “How long have you lived in the United

States?” What has your experience been

since coming to the U.S. (or the city)?”

• “How has your life changed since coming to the U.S.?”

• “What language are you most comfortable using when talking about your health


• “What were other important times in your life that might help us better understand

your situation?”

Decision-making style: • What is the general decision-making style

of the cultural group and specifically of the patient and family?

• Is the emphasis on the individual decision- making process or the family decision- making process?

• “How are decisions about health care made in your family?”

• “Who is the head of the family?” • “Is there anyone else I should talk to in

your family about your condition?”

From: Cultural Relevance in End-of-Life Care

http://ethnomed.org/clinical/end-of-life/cultural-relevance-in-end-of-life-care 2

Environment: • What resources and support are available

to the patient and family? • What resources are available to assist the

health care provider to interpret the significance of the patient’s culture?

• Identify community resources that may be of assistance to the health care provider

and the patient and family, such as

translators, health care workers from the

same community as the patient,

community associations, religious leaders,

and healers.

Kagawa-Singer, M., & Backhall, L. (2001). Negotiating cross-cultural issues at end of life. Journal of American Medical Association, 286(3001), 2993-.

  • Kagawa-Singer & Blackhall’s ABCD Cultural Assessment Model