Conclusions
Competing demands on the time available to hospice providers mean that in-person educational programs are very limited. What is not available today is a cost- and time-efficient educational intervention that addresses the need for cultural competence education among hospice providers. The web-based design of this training provided an innovative approach to the problem of time- and cost-effective cross-cultural communication education. Internet cultural competence training can (a) reduce costs for in-service education; (b) increase active learning through a selfpaced format; (c) increase the consistency of instruction and experiential learning; and (d) facilitate organizational tracking of cultural competence training. Based on the qualitative results of this study, hospice providers found the training to be engaging and effective. Participants made suggestions for refining and expanding Culture & End-of-Life: for example, adding content on working with interpreters, increasing coverage of traditional, culturespecific therapies and strengthening information on incorporating complementary therapies into hospice care.

The significant change in cultural competence scores from pre-intervention to post-intervention suggests the present study holds great promise for the future of web-based interventions to enhance cultural competence among hospice providers. Enhancing cultural competence among hospice providers is a critical step toward achieving societal goals regarding diversity inclusion, and the provision of culturally congruent care. Future research is needed to expand and refine the Culture & End-of Life web-based training, offer it to a larger sample in a controlled trial design, and evaluate its effects on patient outcomes. Such research would provide evidence of the effects of web-based educational interventions for hospice providers.

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