Reframing professional practice in palliative care through cultural humility : Insights from a participatory action research study

Workman, Siobhan and Swarbrick, Caroline and Ashmore, Lisa (2026) Reframing professional practice in palliative care through cultural humility : Insights from a participatory action research study. PhD thesis, Lancaster University.

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Abstract

Background: Palliative care is founded on principles of dignity, compassion, and respect. However, for many older people who are sexual and gender diverse, end-of-life care remains shaped by inequity, invisibility, and fear of discrimination. Despite equality legislation and person-centred frameworks, heteronormative assumptions and systemic barriers persist within healthcare practice. These barriers undermine the ethos of palliative care, which is to recognise and respond to everyone's unique identity, experiences, and values. Aim: The thesis explores cultural humility as a conceptual and practical framework for reframing professional practice in palliative care. It examines how healthcare staff understand and engage with cultural humility, and how it may contribute to more inclusive, equitable, and person-centred care for older people who are sexual and gender diverse. Methods: A qualitative participatory action research design was used, engaging six members of healthcare staff and the researcher as co-researchers over a 15-month period. Four iterative cycles of action and reflection were undertaken using focus groups, reflective exercises, and diaries. Reflexive thematic analysis guided data interpretation and synthesis. Findings: Cultural humility emerged as a multidimensional and ongoing process involving self-awareness, reflexivity, vulnerability, and empathy. Participants described a shift from cultural knowledge to cultural engagement, underpinned by a willingness to unlearn assumptions and critically reflect on practice. Organisational barriers, including hierarchical structures and competing priorities, were identified alongside opportunities to embed cultural humility within education, supervision, and leadership. From this collaborative inquiry, the Cultural Humility in Palliative Care framework and HEARt Model were developed to guide practitioners in applying cultural humility within palliative care settings. Conclusion: This study positions cultural humility as a lifelong, relational practice essential to ethical and person-centred care. By distinguishing it from static notions of competence, the research contributes new insights into how reflective, participatory approaches can strengthen inclusivity and equity within palliative care, reaffirming its core commitment to compassion, dignity, and justice at the end of life. Ultimately, it proposes that cultural humility, when practised authentically, has the potential to transform both the giver and receiver of care.