APPEAL Training Program
Training Clinicians to Care for African-Americans at the End of Life

The Challenge

Many African-Americans distrust the health-care system and worry that those who care for them don’t share their values or beliefs. Such feelings are often most pronounced when patients and their families are confronting advanced illness, and many doubt that they will receive palliative and end-of-life care in accordance with their personal wishes and cultural preferences. Similarly, clinicians from different ethnic or cultural traditions often describe feeling ill-equipped to discuss end-of-life treatment options with their African-American patients. One palliative-care nurse, for example, in exploring advance directives with her African-American patient, remarked, “I look like a white woman trying to rush you to your death.” Needed is a community of trained caregivers, from physicians to pastors, who can provide the physical, social, emotional and spiritual support to African-American patients in a way that respects individual and cultural values, beliefs and preferences.

“When I go for my doctor visits, he never even asks me what I think. Am I supposed to believe that if I’m in a coma, he would honor what I put on a piece of paper? I don’t think so.”
— African-American patient interviewed for the APPEAL training video

ICEOL’S Response

Through the leadership of the Duke Institute on Care at the End of Life’s (ICEOL’s) director, Dr. Richard Payne, an interdisciplinary team of African-American experts in palliative care has developed APPEAL (A Progressive Palliative Care Educational Curriculum for the Care of African-Americans at Life’s End).  APPEAL provides palliative-care knowledge and skills, hand-in-hand with insights into caring for African-American patients with advanced illnesses and their families. ICEOL has secured seed money to launch this training.

As an interactive program that employs a variety of adult-learning techniques, APPEAL’s eight modules cover death and dying in African-American communities, patient education and decision-making, fundamentals of hospice care, culturally appropriate communication, pain treatment and racial disparities, and spirituality in end-of-life care. Content is designed for physicians, nurses, social workers, pharmacists, clergy, psychologists, counselors, hospital and hospice administrators, and family caregivers who work with African-American patients and their families. Interdisciplinary teams are encouraged to attend the training together, as well as develop action plans that will allow them to further apply their learning.

The Future

  • ICEOL will use the grant funds to present training in four locations in 2008, in partnership with medical centers and hospices
  • Given that the opportunities to partner with communities across the country are vast, ICEOL will continue its work to increase the availability of APPEAL training nationwide.
  • ICEOL will develop a template for APPEAL training, refresh the curriculum through continuous-quality improvement and maintain a team of highly trained interdisciplinary faculty.