The patient identifies herself as Jewish, but what does that mean? Orthodox? Conservative? Reform? And is she religiously or culturally Jewish? Observant or not? This is just one of the dilemmas faced by hospitals in treating patients from various religious, ethnic and racial backgrounds.

According to the U.S. Census Bureau, minorities currently account for about a third of this country's population. Moreover, by 2042, minorities will represent the majority of the population and by 2050 eventually will make up as much as 54 percent of the population.

As the country becomes more of a melting pot, hospitals must increasingly care for patients with a wide variety of cultural backgrounds. Understanding their wishes is especially important when considering palliative or hospice care.

"We distribute some fact sheets about different cultures and religions to our staff," says Katherine Puckett, national director of mind and body medicine at Cancer Treatment Centers of America, "but we never assume that those facts fit any individual. And we never assume that because an individual identifies with a certain group, we'll know what that person needs. Instead, we find out what each patient wants."

Another aspect of cultural competence is speaking and understanding the patient's language. Barnes–Jewish Hospital in St. Louis, for instance, has a professional interpreting service with more than 80 languages. "We constantly ask ourselves, 'How can we meet the needs of people and communities?' " says Vic Trogdon, director of spiritual care services at the hospital.

It all starts with data collection. "We always collect demographics on patients — who they are, who's the decision-maker in their family, what ethic or cultural group they identify with, who's their tribe," says Martha L. Twaddle, M.D., chief medical officer at Midwest Palliative & Hospice CareCenter. "We find out what's important to them. We learn how much information each patient wants about their illness. That way, we give them confidence that we're being respectful of their needs."