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Burke C, Doody O, Lloyd B. Healthcare practitioners' perspectives of providing palliative care to patients from culturally diverse backgrounds: a qualitative systematic review. BMC Palliat Care 2023; 22:182. [PMID: 37978500 PMCID: PMC10655398 DOI: 10.1186/s12904-023-01285-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/13/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Palliative care practitioners are increasingly caring for patients and families from diverse cultural backgrounds. There is growing awareness of the influence of culture on many aspects of care in the palliative phase of an illness. However, disparities have been noted in the provision of palliative care to patients from culturally diverse backgrounds and challenges have been reported in meeting their needs and those of their families. METHOD A qualitative systematic review of research papers identified through searching four databases. Papers were screened against inclusion criteria within the timeframe of January 2012 to March 2022. Data was extraction from all included studies and methodological quality assessed utilising the Critical Appraisal Skills Programme Tool. Thematic analysis followed Braun and Clarke's framework and the review is reported in line with PRISMA guidelines. FINDINGS The search yielded 1954 results of which 26 were included for appraisal and review. Four themes were identified: communication and connection, the role of the family in death and dying, the role of education in addressing uncertainty, and institutional and societal factors. The findings highlighted challenges of communication and a fear of acting in a culturally insensitive way, the pivotal role of the family, the need for an individualised approach to care, the universality of needs when approaching end of life and the need for education of practitioners. CONCLUSION These findings suggest that healthcare practitioners draw on their existing skills to adapt their practice to meet the needs of patients from culturally diverse backgrounds. However, results also indicate a need for further education and identification of educational approaches best suited to supporting healthcare professionals in practice.
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Affiliation(s)
- Colette Burke
- Milford Care Centre, Castletroy, Limerick, V94 H795, Ireland
| | - Owen Doody
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Barbara Lloyd
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, V94 T9PX, Ireland.
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Singer S, Riccetti N, Hempler I, Fried M, Knorrenschild JR, Kalie L, Merbach M, Reiser M, Mosthaf F, Heidt V, Hermes-Moll K. Awareness and use of psychosocial care among cancer patients and their relatives-a comparison of people with and without a migration background in Germany. J Cancer Res Clin Oncol 2023; 149:1733-1745. [PMID: 35689688 PMCID: PMC9188276 DOI: 10.1007/s00432-022-04091-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/24/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE We examined how migration background is associated with awareness and usage of psycho-oncology services. METHODS Oncologists in community-based practices and outpatient clinics asked their patients and their relatives to complete a questionnaire. Migrants were purposely over-sampled. The questionnaire was provided in Arabic, English, Farsi, French, German, Hindi, Kurdish, Pashto, Russian, Somali, Turkish, Urdu, and Vietnamese. RESULTS From 9 collaborators, 177 participants were enrolled (130 with and 47 without migration background). The existence of outpatient cancer counselling centres was known to 38% of the participants without and 32% with migration background, self-help groups to 32 vs. 12%, and psychotherapy to 43 vs. 25%. Respondents from the Near and Middle East were less likely to know about psychotherapy (odds ratio (OR) 0.1, p = 0.01); those from the Commonwealth of the Independent States or former Yugoslavia were less often informed about self-help groups (OR 0.1, p = 0.06). Migrants retrieved information less frequently from the internet than non-migrants (10 vs. 25%). At least one service had been used by 27% of migrants and 42% of non-migrants (OR 0.5, p = 0.06). After adjusting for gender, age, education, and patient-relative status, there was no evidence for an association between migration background and service use. CONCLUSIONS Migrants should be better informed about psychotherapy and self-help groups, in particular the ones coming from the Near or Middle East and the Commonwealth of the Independent States or former Yugoslavia. The under-use of psychosocial services can largely be explained by confounding factors. Therefore, these factors must always be taken into account when analysing the use of psychosocial services in the aforementioned populations.
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Affiliation(s)
- Susanne Singer
- Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre, Johannes Gutenberg University, Obere Zahlbacher Straße 69, 55131, Mainz, Germany.
- University Cancer Centre, Mainz, Germany.
| | - Nicola Riccetti
- Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre, Johannes Gutenberg University, Obere Zahlbacher Straße 69, 55131, Mainz, Germany
- University Cancer Centre, Mainz, Germany
| | - Isabelle Hempler
- Scientific Institute of Office-Based Haematologists and Oncologists (WINHO), Cologne, Germany
| | | | | | - Louma Kalie
- Institute of Pharmaceutical Sciences, Department of Pharmaceutical Technology and Biopharmacy, Albert-Ludwigs-University, Freiburg, Germany
| | - Martin Merbach
- Central Institute for Family Counselling, Berlin, Germany
- Association of Binational Families and Couples, Berlin, Germany
| | - Marcel Reiser
- Community-Based Practice for Medical Oncology, Cologne, Germany
| | - Franz Mosthaf
- Gemeinschaftspraxis für Hämatologie, Onkologie und Infektiologie, Zentrum für Ambulante Onkologie, Karlsruhe, Germany
| | - Vitali Heidt
- Scientific Institute of Office-Based Haematologists and Oncologists (WINHO), Cologne, Germany
| | - Kerstin Hermes-Moll
- Scientific Institute of Office-Based Haematologists and Oncologists (WINHO), Cologne, Germany
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Shabnam J, Timm HU, Nielsen DS, Raunkiaer M. Development of a complex intervention (safe and secure) to support non-western migrant patients with palliative care needs and their families. Eur J Oncol Nurs 2023; 62:102238. [PMID: 36459811 DOI: 10.1016/j.ejon.2022.102238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/31/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE International evidence supports the benefits of early use of palliative care, although the best use of services is often under-utilised among Danish migrants. The study aims to develop a theoretically informed, evidence-based intervention to increase support in palliative care service provision among non-western migrant patients with a life-threatening disease and their families in Denmark. METHODS The overall approach was guided by the United Kingdom Medical Research Council framework for developing and evaluating complex interventions by involving stakeholders for example patients, family caregivers, and healthcare professionals. The intervention was developed iteratively by incorporating theory and evidence. Evidence was synthesized from a systematic review, semi-structured interviews, and group discussions with patients (n = 8), family caregivers (n = 11), healthcare professionals (n = 10); and three workshops with migrants (n = 5), social and healthcare professionals (n = 6). The study took place in six different settings in two regions across Denmark. RESULTS The safe and secure complex intervention is a healthcare professional (e.g. nurse, physiotherapist, or occupational therapist) led patient-centred palliative care intervention at the basic level. The final intervention consists of three components 1. Education and training sessions, 2. Consultations with the healthcare professional, and 3. Coordination of care. CONCLUSION This study describes the development of a supportive palliative care intervention for non-western migrant patients with palliative care needs and their families, followed by a transparent and systematic reporting process. A palliative care intervention combining multiple components targeting different stakeholders, is expected that safe and secure is more suitable and well customized in increasing access and use of palliative care services for non-western migrant families in Denmark.
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Affiliation(s)
- Jahan Shabnam
- REHPA, Danish Knowledge Centre of Rehabilitation and Palliative Care, Odense University Hospital, Vestergade 17, 5800 Nyborg, Denmark; Department of Clinical Research, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark.
| | - Helle Ussing Timm
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455, Copenhagen, K, Denmark; University Hospitals Center for Health Research (UCSF), Rigshospital, Denmark.
| | - Dorthe Susanne Nielsen
- Geriatric Department G, Odense, Odense University Hospital, Kløvervænget 23, 5000, Odense C, Denmark.
| | - Mette Raunkiaer
- REHPA, Danish Knowledge Centre of Rehabilitation and Palliative Care, Odense University Hospital, Vestergade 17, 5800 Nyborg, Denmark; Department of Clinical Research, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark.
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Tee S, Üzar-Özçetin YS, Trenoweth S. Achieving culturally competent mental health care: A mixed-methods study drawing on the perspectives of UK nursing students. Perspect Psychiatr Care 2022; 58:1267-1280. [PMID: 34378792 DOI: 10.1111/ppc.12926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 07/13/2021] [Accepted: 07/21/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This study aimed to examine the degree of cross-cultural competency among UK mental health student nurses, and the care delivery challenges arising from their internalized cultural assumptions. DESIGN AND METHODS This study adopted a mixed-methods design. Participants were final-year nursing students in the United Kingdom. FINDINGS The results revealed participants had a moderate level of cultural awareness and competency but highlighted many challenges to providing cross-cultural care arising from the meanings, enablers, and values they attributed to culturally competent mental health care. PRACTICE IMPLICATIONS As cultural competency is considered an essential characteristic of effective nursing care, greater attention should be paid to how student nurses assimilate cultural awareness to develop confidence in their day-to-day practice.
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Affiliation(s)
- Stephen Tee
- The Business School, Faculty of Health and Social Sciences, Bournemouth University, Dorset, UK
| | | | - Steve Trenoweth
- BU iWell Research Centre, Faculty of Health and Social Sciences, Bournemouth University, Dorset, UK
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Akoo C, McMillan K. An Evolutionary Concept Analysis of Palliative Care in Oncology Care. ANS Adv Nurs Sci 2022; 46:199-209. [PMID: 36006006 DOI: 10.1097/ans.0000000000000444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This evolutionary concept analysis reports on the concept of palliative care in oncology. Despite its relevance to oncology, the concept of palliative care remains misunderstood, resulting in erroneous interpretations by nurses and health care providers alike. Consequently, integration of palliative care remains heterogeneous and highly contextual. Findings highlight the complexity and ambiguity of the concept of palliative care in the context of oncology care. The nuances and complexity of when to integrate palliative care for patients living with cancer, as well as its evolution from its origins in the hospice movement, have led to its ambiguity in clinical practice.
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Affiliation(s)
- Chaman Akoo
- School of Nursing, University of Ottawa, Ottawa, Canada
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Shabnam J, Timm HU, Nielsen DS, Raunkiær M. Palliative Care Utilisation Among Non-Western Migrants in Denmark: A Qualitative Study Of the Experiences of Patients, Family Caregivers and Healthcare Professionals. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221111933. [PMID: 35786059 DOI: 10.1177/00302228221111933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study explores care experiences while utilising palliative care services of non-western migrant families from the perspectives of patients, family caregivers, and healthcare professionals in Denmark. Twenty-three semi-structured individual and group interviews were conducted among eight patients with a life-threatening disease, 11 family caregivers, and ten healthcare professionals. Thematic analysis revealed three themes: 1) Communication between families and healthcare professionals; 2) Building and lack of trusting relations, and feeling safe, and 3) Access to information and navigating in the healthcare system. Moreover, ''language and culture'' emerged as transaction themes that are not mutually exclusive, however, interconnect across the mentioned three themes. Non-western migrant families can be supported by healthcare professionals' cultural competency training, negotiating on providing services concerning information, patient preferences, family involvement, and palliative care setting. This study findings urge inter-sectoral collaboration to ensure needs-oriented and linguistically and culturally appropriate palliative care services for non-western migrant families in Denmark.
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Affiliation(s)
- Jahan Shabnam
- REHPA, Danish Knowledge Centre of Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Helle Ussing Timm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- University Hospitals Center for Health Research (UCSF), Rigshospital, Copenhagen, Denmark
| | - Dorthe Susanne Nielsen
- Migrant Health Clinic, Department of Geriatric Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Mette Raunkiær
- REHPA, Danish Knowledge Centre of Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Pirhofer J, Bükki J, Vaismoradi M, Glarcher M, Paal P. A qualitative exploration of cultural safety in nursing from the perspectives of Advanced Practice Nurses: meaning, barriers, and prospects. BMC Nurs 2022; 21:178. [PMID: 35787799 PMCID: PMC9251927 DOI: 10.1186/s12912-022-00960-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 06/27/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Cultural safety requires healthcare professionals and organisations to improve healthcare, facilitate patient access to healthcare, and achieve equity within the workforce. METHODS This ethnomethodological study, which consisted of two phases, explored the concept of cultural safety from the perspective of Advanced Practice Nurses. Semi-structured interviews and the nominal group technique were used to prioritise challenges related to cultural safety, identify barriers to clinical practise and assess educational needs. The data collected was subjected to thematic analysis. RESULTS Nurses working in Austria, Germany and Switzerland were recruited (N = 29). Accordingly, the phenomenon of cultural safety in health care is not generally known and there is little prior knowledge about it. The most frequently discussed themes were communication difficulties, lack of knowledge, the treatment of people with insufficient language skills and expectations of treatment goals and outcomes, which can lead to conflicts and accusations of unequal treatment due to diverse cultural backgrounds. CONCLUSION Diverse cultures are encountered in German-speaking healthcare settings. Cultural safety is also about healthcare staff, as nurses with different socialisations encounter prejudice, discrimination and racism. Although the issue of power was not discussed, academic nurses were willing to make an effort to change. Only a minority were aware that lasting change requires challenging one's own cultural structures and adapted behaviours, rather than pushing for the mere acquisition of cultural competence. Organisations were encouraged to introduce self-reflection sessions and provide better access to translation services to improve equity and support nurses.
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Affiliation(s)
- Jacqueline Pirhofer
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
| | - Johannes Bükki
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
- Diakonie-Klinikum Stuttgart, Rosenbergstrasse 38, 70176, Stuttgart, Germany
| | - Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, 8049, Bodø, Norway
| | - Manela Glarcher
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
| | - Piret Paal
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria.
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Hökkä M, Pölkki T, Lehto JT. Nursing Students' Views of the Content of Palliative Care in Undergraduate Education and their Self-assessed Palliative Care Competence-A Nationwide Cross-sectional Study. J Palliat Care 2022; 37:434-442. [PMID: 35286180 DOI: 10.1177/08258597221084445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The importance of integrating palliative care (PC) education into undergraduate nursing studies has been recognized. Still, there is considerable variation in the PC education of nurses. OBJECTIVE To study the nursing students' views of the PC contents during the nursing education; students' self-assessed levels of PC competence; and whether prior education or work experience influence these views. METHODS A cross-sectional study. Data were collected using a questionnaire which was tested for its content and construct validity and internal consistency. The sample consisted of final-year undergraduate nursing students (n = 1331) from Finland. RESULTS The response rate was 94%. Of the students, 94.4% considered PC education to be quite or very useful, but only 51.9% reported the achieved PC teaching as quite or very good. Teaching on mental symptoms, existential issues and multicultural aspects were considered incomplete. Over half of the students wanted more education on pharmacological- and non-pharmacological pain management. Students with previous education assessed their PC competence as quite or very good more often than other students (70.1% vs. 54%, P < .001), and more often felt that these competencies are relevant to their profession (72.2% vs. 57.6%, P < .001). CONCLUSION PC was considered as a useful subject, still only about half of the students reported the received PC education and their competence on PC as sufficient. Previous education or experience may enhance PC competence highlighting the need for divergent teaching. The results identify development needs for the contents of PC education in undergraduate nursing studies.
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Affiliation(s)
- Minna Hökkä
- Faculty of Medicine, Research Unit of Nursing Science and Health Management, University of Oulu, Finland.,Kajaani University of Applied Sciences, Kajaani, Finland
| | - Tarja Pölkki
- Faculty of Medicine, Research Unit of Nursing Science and Health Management, University of Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Juho T Lehto
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Palliative Care Centre and Department of Oncology, Tampere University Hospital, Tampere, Finland
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Palliative Care Utilization Among Non-Western Migrants in Europe: A Systematic Review. J Immigr Minor Health 2021; 24:237-255. [PMID: 34709528 DOI: 10.1007/s10903-021-01302-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2021] [Indexed: 10/20/2022]
Abstract
The paper aims to identify and describe the European evidence on opportunities and barriers to access and utilization of palliative care among non- western migrants. A systematic review in accordance with PRISMA guidelines was conducted in June 2020, searching Medline, CINAHL, PsychINFO and EMBASE databases. PROSPERO# CRD42020193651. Studies included empirical research published between 2011 and 2020. Search words were, for example, ethnic groups and palliative care. Thematic analysis was used to analyze data. Twenty nine qualitative and six quantitative studies were included. Four main themes were identified: communication and language; knowledge and awareness; patient preferences, cultural and religious issues; and lack of resources at different levels of palliative care service provision. Migrants' access to palliative care is impeded at system, community and individual levels, yet, recommendations are mostly at the individual level. Closer attention is required to these different levels when designing future palliative interventions for migrants.
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Weber O, Semlali I, Gamondi C, Singy P. Cultural competency and sensitivity in the curriculum for palliative care professionals: a survey in Switzerland. BMC MEDICAL EDUCATION 2021; 21:318. [PMID: 34088305 PMCID: PMC8178817 DOI: 10.1186/s12909-021-02745-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/12/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Cultural and linguistic diversity in patients and their relatives represents a challenge for clinical practice in palliative care around the world. Cross-cultural training for palliative care professionals is still scarce, and research can help determine and support the implementation of appropriate training. In Switzerland, health policies address diversity and equity issues, and there is a need for educational research on cross-cultural training in palliative care. The aim of this study was to investigate the clinical challenges faced by Swiss palliative care professionals when working with migrant patients and their relatives. We also documented professionals' interests in cross-cultural training. METHODS A web survey of professionals working in specialized palliative care in the French- and Italian-speaking areas of Switzerland investigated clinical challenges with migrant populations and interests in various training opportunities. RESULTS A total of 204 individuals responded to the survey, 48.5 % of whom were nurses. The major difficulties they reported were communication impediments associated with patients' linguistic and/or cultural backgrounds. In relation to educational needs, they expressed a particular interest in communication techniques that would allow them to deal with these issues autonomously. The professionals expressed less interest in training on collaborating with other professionals and examining one's own stereotypes. CONCLUSIONS Palliative care professionals' post-graduate and continuing education must address communication techniques for sensitive palliative and end-of-life topics in cross-cultural contexts. Beginning with their pre-graduate studies, health professionals should assimilate the importance of collaborating with other professionals in complex cross-cultural situations and learn to reflect on their stereotypes and pre-conceptions in clinical practice.
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Affiliation(s)
- Orest Weber
- Liaison Psychiatry Service, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Imane Semlali
- Liaison Psychiatry Service, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland.
- Liaison Psychiatry service, Av. de Beaumont 23, 1011, Lausanne, Switzerland.
| | - Claudia Gamondi
- Palliative and Supportive Care Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Pascal Singy
- Liaison Psychiatry Service, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
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Dignity-conserving palliative care in a diverse population: A qualitative study of physicians' perspective. Palliat Support Care 2021; 20:196-202. [PMID: 33952366 DOI: 10.1017/s147895152100050x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Preserving personal dignity is an important aim of palliative care. Little is known about how physicians perceive and preserve dignity of patients from non-western migration backgrounds. Insight in this is important given the increased demand for culturally sensitive palliative care. AIM To gain insight in how Dutch physicians perceive and preserve dignity in the last phase of life for patients from non-western migration backgrounds. DESIGN Qualitative thematic analysis of semi-structured interviews. PARTICIPANTS Fifteen physicians experienced in palliative care. RESULTS Physicians experienced dilemmas in preserving dignity of non-western patients in three situations: (a) relief of suffering in the terminal phase, (b) termination of interventions and treatment, and (c) disclosure of diagnosis. Physicians wanted to grant the needs of patients in the last phase of their lives, which was central to physicians' view on dignity, but dilemmas arose when this conflicted with physicians' other personal and professional values. To make the dilemmas manageable, physicians assessed whether needs of patients were authentic, but due to linguistic, cultural, and communication barriers, this was difficult with non-western patients. To find a way out of the dilemmas, physicians had three strategies: accept and go along with patient's wishes, convince or overrule the patient or family, or seek solutions that were acceptable for all. CONCLUSIONS Physicians encounter dilemmas providing palliative care for people from non-western backgrounds. Future physicians can be trained in connective strategies and seeking middle grounds to optimally preserve patients' dignity while being in concordance with their personal and professional values.
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12
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Yeung CW, Gilbertson-White S, Wickersham KE. "Live your life cuz everybody's terminal": Describing emotions and coping behaviors of rural advanced cancer patients. J Rural Health 2021; 38:63-69. [PMID: 33856695 DOI: 10.1111/jrh.12576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Culturally competent health care has led to increasing interest in how patients' identities influence the management of their health. The ways rural patients with advanced cancer process emotions and cope with their disease may be influenced by their rural context. The aims for this study were to (1) describe the emotions rural cancer patients experience, (2) describe how rural cancer patients manage their emotions within their rural context, and (3) interlace the themes related to coping with emotions. METHODS This paper is a subanalysis of a larger project focused on symptom management among rural patients living with advanced cancer. Using a qualitative descriptive design, authors read and coded patient interview transcripts to extract key perspectives related to managing emotions within a rural context. FINDINGS Sixteen participants, 10 men and 6 women, with a mean age of 68.75 years completed this study. Participants described a spectrum of emotional experiences. Some participants reported no distress, and some described high levels of distress. While previous writers described low levels of religious coping among rural patients, participants in this study often named their faith/spirituality as a major source of emotional coping. Participants also galvanized their social support network, particularly those in their religious community. Finally, participants in this study reported the use of medication as a last resort. CONCLUSION Results from this study might be influenced from cultural variables found in the rural community; specifically, religiosity and close social networks. Future interventions need to be tailored to the unique responses of rural patients.
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Affiliation(s)
- Chi W Yeung
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | - Karen E Wickersham
- University of South Carolina College of Nursing, Columbia, South Carolina, USA
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de Voogd X, Willems DL, Onwuteaka-Philipsen B, Torensma M, Suurmond JL. Health care staff's strategies to preserve dignity of migrant patients in the palliative phase and their families. A qualitative study. J Adv Nurs 2021; 77:2819-2830. [PMID: 33755223 DOI: 10.1111/jan.14829] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/13/2021] [Accepted: 03/05/2021] [Indexed: 11/28/2022]
Abstract
AIMS To determine registered nurses' and care assistants' difficulties and strategies for preserving dignity of migrant patients in the last phase of life and their families. BACKGROUND Preserving dignity of patients in a palliative phase entails paying attention to the uniqueness of patients. Migrant patients often have particular needs and wishes that care staff find difficult to address, or meet, and hence the patient's dignity might be at stake. METHODS We performed five focus group discussions with care staff and one with key figures with diverse ethnic backgrounds in the Netherlands (2018-2020). Thematic analysis was used. RESULTS Care staff creatively safeguarded the patient's dignity in daily care by attending to personal needs concerning intimate body care and providing non-verbal attention. Care staff had difficulties to preserve dignity, when the patient's family engaged themselves in the patient's choices or requests. According to care staff, the interference of family impeded the patient's quality of life or threatened the patient's dignity in the last days, or family member's choices (seemingly) prevailed over the patient's wishes. Care staff safeguarded dignity by catering to cultural or religious practices at the end of life and employing cultural knowledge during decision making. Key figures emphasized to make decisions with patient and family together and to listen more carefully to what patients mean. Bypassing family was experienced as harmful, and repetitively informing family, about, for example, the patient's disease or procedures in the nursing home, was experienced as ineffective. CONCLUSION To preserve the patient's dignity, attention is needed for relational aspects of dignity and needs of family, next to patients' individual needs. IMPACT Care staff should be supported to employ strategies to engage family of migrant patients, by, for example, acknowledging families' values, such as giving good care to the patient and the importance of religious practices for dignity.
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Affiliation(s)
- Xanthe de Voogd
- Amsterdam UMC, Department of Public & Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Dick L Willems
- Amsterdam UMC, Department of Ethics, Law and Humanities, Amsterdam UMC Expertise Center for Palliative Care and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Bregje Onwuteaka-Philipsen
- Amsterdam UMC, Department of Public & Occupational Health, Amsterdam UMC Expertise Center for Palliative Care and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Marieke Torensma
- Amsterdam UMC, Department of Public & Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Jeanine L Suurmond
- Amsterdam UMC, Department of Public & Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
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14
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Balante J, Broek DVD, White K. How does culture influence work experience in a foreign country? An umbrella review of the cultural challenges faced by internationally educated nurses. Int J Nurs Stud 2021; 118:103930. [PMID: 33819641 DOI: 10.1016/j.ijnurstu.2021.103930] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 03/05/2021] [Accepted: 03/10/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Internationally educated nurses experience multidimensional challenges affecting their acculturation process in a foreign country. Cultural differences have been highlighted by research as a common barrier. There is a need to understand the cross-cultural challenges experienced by internationally educated nurses to promote a culturally inclusive workplace, particularly when these nurses practice in another country wherein cultural attitudes and beliefs are different from their own. OBJECTIVES To identify and synthesise the challenges to cultural values, beliefs, and practices of internationally educated nurses working in a foreign country. DESIGN An umbrella review was undertaken by synthesising evidence from systematic reviews. DATA SOURCES Databases searched were MEDLINE, Embase, PsychINFO, CINAHL and Scopus. Reviews published between 2000-2019 were considered. METHODS The review protocol was guided by the guidelines from the Joanna Briggs Institute. The Joanna Briggs Institute Critical Appraisal Instrument for Systematic Reviews and Research Syntheses was used to evaluate the methodological quality of the retrieved reviews. The extracted findings were tabulated, categorised into themes, and presented in a narrative synthesis. RESULTS Ten reviews met the inclusion criteria. These reviews examined the experiences of internationally educated nurses from different countries. The reviews highlighted that cultural differences had impacted the adaptation and professional experiences of internationally educated nurses. Four themes were identified: cultural differences lead to the feeling of being an outsider, intercultural communication issues transcend beyond fluency, differing nursing cultures complicate adaptation, and ethnic identity challenges work adjustment. CONCLUSIONS Despite having a great interest in the literature on the experiences and issues faced by internationally educated nurses, a distinct gap still exists. There is an absence of knowledge on the challenges experienced by internationally educated nurses concerning their cultural beliefs, values, and practices. Further work is needed to enhance understanding and to promote a culturally sensitive workplace.
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Affiliation(s)
- Jay Balante
- Cancer Nursing Research Unit, Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Level 6 - North, Chris O'Brien Lifehouse, Camperdown NSW 2050, Australia.
| | - Diane van den Broek
- Discipline of Work and Organisational Studies, Business School, The University of Sydney, Corner Abercrombie Street and Codrington St, Darlington NSW 2006, Australia.
| | - Kate White
- Cancer Nursing Research Unit, Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Level 6 - North, Chris O'Brien Lifehouse, Camperdown NSW 2050, Australia.
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Sacchi S, Capone R, Ferrari F, Sforacchi F, Di Leo S, Ghirotto L. "Achieve the best while rushing against time": A grounded theory study on caring for low-income immigrant cancer patients at end of life. Palliat Med 2021; 35:426-436. [PMID: 33356971 DOI: 10.1177/0269216320974275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Between 2000 and 2020, Europe experienced an annual net arrival of approximately 1.6 million immigrants per year. While having lower mortality rates, in the setting of severe diseases, immigrants bear a greater cancer-related burden due to linguistic and cultural barriers and socio-economic conditions. Professionals face a two-fold task: managing clinical conditions while considering the social, economic, cultural, and spiritual sphere of patients and their families. In this regard, little is known about the care provision to low-income immigrant cancer patients in real contexts. AIM To investigate the perspective of professionals, family members, and stakeholders on the caring process of low-income immigrant cancer patients at the end of life. DESIGN A Constructivist Grounded Theory study. SETTING/PARTICIPANTS The study, conducted at a Hospital in Northern Italy, involved 27 participants among health professionals, family caregivers, and other stakeholders who had recently accompanied immigrant cancer patients in their terminal phase of illness. RESULTS Findings evidenced that professionals feel they were not adequately trained to cope with immigrant cancer patients, nonetheless, they were highly committed in providing the best care they could, rushing against the (short) time the patients have left. Analyses evidenced four main categories: "providing and receiving hospitality," "understanding each other," "addressing diversity," and "around the patient," which we conceptualized under the core category "Achieve the best while rushing against time." CONCLUSIONS The model reveals the activation of empathic and compassionate behavior by professionals. It evidences the need for empowering professionals with cultural competencies by employing interpreters and specific training programs.
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Affiliation(s)
- Simona Sacchi
- Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Roberto Capone
- Department of Rehabilitation, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Ferrari
- Department of Neurology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Federica Sforacchi
- Guastalla Hospice, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Di Leo
- Psycho-oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luca Ghirotto
- Qualitative Research Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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16
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de Voogd X, Oosterveld-Vlug MG, Torensma M, Onwuteaka-Philipsen BD, Willems DL, Suurmond JL. A dignified last phase of life for patients with a migration background: A qualitative study. Palliat Med 2020; 34:1385-1392. [PMID: 32912088 PMCID: PMC7543003 DOI: 10.1177/0269216320948708] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Preserving personal dignity is an important part of palliative care. Generally, autonomy, independency and not being a burden to others are emphasised for preserving dignity. Dignity has not been studied yet from the perspective of the growing group of patients with a migration background living in Western countries. AIM To gain insight into (1) what patients - and their relatives - with a Turkish, Moroccan or Surinamese background, living in the Netherlands, in their last phase of life find important aspects of dignity, and (2) how care professionals can preserve and strengthen the dignity of these patients. DESIGN Qualitative thematic analysis of semi-structured interviews. PARTICIPANTS A total of 23 patients and 21 relatives with a Turkish, Moroccan or Surinamese background were interviewed. RESULTS For respondents dignity encompassed surrender to God's or Allah's will and meaningful relationships with others, rather than preserving autonomy. Surrender to God or Allah meant accepting the illness, the situation and performing religious practice. A meaningful relationship meant being assisted or cared for by family members and maintaining a social role. Professionals could preserve dignity by showing respect and attention; guaranteeing physical integrity, hygiene and self-direction; and indirect communication about diagnoses and prognoses. CONCLUSIONS Religion and appropriate involvement of family members are important aspects of dignity in the last phase of life, in addition to autonomy and independency. Care professionals need to take these factors into account in order to provide person-centred care.
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Affiliation(s)
- X de Voogd
- Department of Public Health, Amsterdam UMC and Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - M G Oosterveld-Vlug
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands
| | - M Torensma
- Department of Public Health, Amsterdam UMC and Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - B D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam UMC Expertise center for Palliative Care and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - D L Willems
- Department of General Practice, Amsterdam UMC Expertise center for Palliative Care and Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - J L Suurmond
- Department of Public Health, Amsterdam UMC and Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Semlali I, Tamches E, Singy P, Weber O. Introducing cross-cultural education in palliative care: focus groups with experts on practical strategies. BMC Palliat Care 2020; 19:171. [PMID: 33172461 PMCID: PMC7656760 DOI: 10.1186/s12904-020-00678-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/28/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The linguistic and cultural diversity found in European societies creates specific challenges to palliative care clinicians. Patients' heterogeneous habits, beliefs and social situations, and in many cases language barriers, add complexity to clinicians' work. Cross-cultural teaching helps palliative care specialists deal with issues that arise from such diversity. This study aimed to provide interested educators and decision makers with ideas for how to implement cross-cultural training in palliative care. METHODS We conducted four focus groups in French- and Italian-speaking Switzerland. All groups consisted of a mix of experts in palliative care and/or cross-cultural teaching. The interdisciplinary research team submitted the data for thematic content analysis. RESULTS Focus-group participants saw a clear need for courses addressing cross-cultural issues in end-of-life care, including in medical disciplines outside of palliative care (e.g. geriatrics, oncology, intensive care). We found that these courses should be embedded in existing training offerings and should appear at all stages of curricula for end-of-life specialists. Two trends emerged related to course content. One focuses on clinicians' acquisition of cultural expertise and tools allowing them to deal with complex situations on their own; the other stresses the importance of clinicians' reflections and learning to collaborate with other professionals in complex situations. These trends evoke recent debates in the literature: the quest for expertise and tools is related to traditional twentieth century work on cross-cultural competence, whereas reflection and collaboration are central to more recent research that promotes cultural sensitivity and humility in clinicians. CONCLUSION This study offers new insights into cross-cultural courses in palliative and end-of-life care. Basic knowledge on culture in medicine, variable practices related to death and dying, communication techniques, self-reflection on cultural references and aptitude for interprofessional collaboration are central to preparing clinicians in end-of-life settings to work with linguistically and culturally diverse patients.
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Affiliation(s)
- Imane Semlali
- Liaison Psychiatry Service, Department of Psychiatry, Lausanne University Hospital, Av. de Beaumont 23, 1011, Lausanne, Switzerland.
| | - Emmanuel Tamches
- Palliative & Supportive Care Service, Lausanne University Hospital, Av. Pierre-Decker 5, 1011, Lausanne, Switzerland
| | - Pascal Singy
- Liaison Psychiatry Service, Department of Psychiatry, Lausanne University Hospital, Av. de Beaumont 23, 1011, Lausanne, Switzerland
| | - Orest Weber
- Liaison Psychiatry Service, Department of Psychiatry, Lausanne University Hospital, Av. de Beaumont 23, 1011, Lausanne, Switzerland
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18
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de Voogd X, Willems DL, Onwuteaka-Philipsen B, Torensma M, Suurmond JL. Community Education for a Dignified Last Phase of Life for Migrants: A Community Engagement, Mixed Methods Study among Moroccan, Surinamese and Turkish Migrants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217797. [PMID: 33114464 PMCID: PMC7662901 DOI: 10.3390/ijerph17217797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 11/20/2022]
Abstract
Community engagement and -education are proposed to foster equity in access to care and to ensure dignity of migrant patients in the last phase of life, but evidence is lacking. We evaluated nine community educational interactive meetings about palliative care (136 participants totally)- co-created with educators from our target groups of Moroccan, Surinamese and Turkish migrants—with a mixed methods approach, including 114 questionnaires, nine observations, nine interviews with educators, and 18 pre- and post- group- and individual interviews with participants. Descriptive and thematic analysis was used. 88% of the participants experienced the meetings as good or excellent. Educators bridged an initial resistance toward talking about this sensitive topic with vivid real-life situations. The added value of the educational meetings were: (1) increased knowledge and awareness about palliative care and its services (2) increased comprehensiveness of participant’s wishes and needs regarding dignity in the last phase; (3) sharing experiences for relief and becoming aware of real-life situations. Community engagement and -education about palliative care for migrants effectively increases knowledge about palliative care and is a first step towards improved access to palliative care services, capacity building and a dignified last phase of life among migrants.
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Affiliation(s)
- Xanthe de Voogd
- Amsterdam UMC, Department of Public & Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1100 DD Amsterdam, The Netherlands; (M.T.); (J.L.S.)
- Correspondence: ; Tel.: +31-6136-34476
| | - Dick L. Willems
- Amsterdam UMC, Department of Ethics, Law and Humanities, Amsterdam UMC Expertise Center for Palliative Care and Amsterdam Public Health Research Institute, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands;
| | - Bregje Onwuteaka-Philipsen
- Amsterdam UMC, Department of Public & Occupational Health, Amsterdam UMC Expertise Center for Palliative Care and Amsterdam Public Health Research Institute, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands;
| | - Marieke Torensma
- Amsterdam UMC, Department of Public & Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1100 DD Amsterdam, The Netherlands; (M.T.); (J.L.S.)
| | - Jeanine L. Suurmond
- Amsterdam UMC, Department of Public & Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1100 DD Amsterdam, The Netherlands; (M.T.); (J.L.S.)
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Granek L, Nakash O, Ariad S, Shapira S, Ben-David MA. The Role of Culture/Ethnicity in Communicating with Cancer Patients About Mental Health Distress and Suicidality. Cult Med Psychiatry 2020; 44:214-229. [PMID: 31541335 DOI: 10.1007/s11013-019-09650-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To explore the role of culture in communicating with cancer patients about mental health distress and suicidality. The Grounded Theory method of data collection and analysis was used. Healthcare professionals (HCPs) reported that language competency was a facilitator while being unable to speak the language or understand the nuances of their patient's communication could be a barrier. HCPs noted that being culturally matched with their patients helped them communicate effectively. HCPs also spoke about religious taboos on suicide as being a barrier to having conversations, either because patients did not feel comfortable discussing these issues, or because they perceived that this was not a topic they could bring up. Some HCPs reported that the culture/ethnicity of their patients had no effect on their ability to communicate effectively with them about mental health distress or suicidality. Advancing effective cross-cultural communication is a challenge faced by HCPs. Raising awareness about communication styles is an important step in addressing communication gaps about mental health and suicide with cancer patients. Training should facilitate skill development to engage in a culturally humble approach to cross-cultural communication including diversity training which encourages asking and actively listening to patients' needs and preferences.
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Affiliation(s)
- Leeat Granek
- School of Health Policy and Management, Faculty of Health, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
| | - Ora Nakash
- School for Social Work, Smith College, Northampton, MA, USA.,Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzilya, Israel
| | - Samuel Ariad
- Department of Oncology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Shahar Shapira
- Gender Studies Program, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Merav A Ben-David
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Radiation Oncology Department, Sheba Medical Center, Ramat-Gan, Israel
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Üzar-Özçetin YS, Tee S, Kargın M. Achieving culturally competent cancer care: A qualitative study drawing on the perspectives of cancer survivors and oncology nurses. Eur J Oncol Nurs 2019; 44:101701. [PMID: 31841798 DOI: 10.1016/j.ejon.2019.101701] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/18/2019] [Accepted: 11/24/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this study was to understand how cancer survivors and nurses define and experience cultural care and to make recommendations toward improvements in nursing practice. METHODS The study used a descriptive qualitative design. Data were collected from 29 cancer survivors and 23 oncology nurses by using in-depth semi-structured interviews. Data were transcribed and themes identified. RESULTS Three themes emerged from the data; 1) cross-cultural care expectations, 2) reality of cross-cultural care activities, and 3) improving culturally sensitive care. CONCLUSIONS The data reveals that relationship between the nurse and cancer survivor is critical to an awareness of cultural needs but that nurses need help in raising their own awareness and appreciation of the benefits and impact of culturally competent care. It is only through creating self-awareness amongst nurses, in the context of each survivor and their needs and beliefs, will the standards of practice improve delivering the health outcomes that those in their care deserve.
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Affiliation(s)
- Yeter Sinem Üzar-Özçetin
- Psychiatric Nursing Department, Hacettepe University Faculty of Nursing, PO Box 06100, Sıhhiye-Altındag, Ankara, Turkey.
| | - Stephen Tee
- Faculty of Health and Social Sciences, Executive Dean, The Business School, Bournemouth University, Royal London House, Christchurch Road Bournemouth, Dorset BH1 3LT, UK.
| | - Maral Kargın
- Department of Psychiatry Nursing, Faculty of Health Science, Firat University, PO Box 23119, Elazığ, Turkey.
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Stiefel F, Bourquin C. Moving toward the next generation of communication training in oncology: The relevance of findings from qualitative research. Eur J Cancer Care (Engl) 2019; 28:e13149. [PMID: 31429157 DOI: 10.1111/ecc.13149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 07/01/2019] [Accepted: 08/01/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The critics and recommendations for communication training in oncology call for new ideas, which may contribute to designing the next generation of training. The aim of this work was to search the literature on communication in oncology for empirically grounded observations that might be useful for the development of training approaches. METHODS The approach consists of identifying findings that might serve as cues for the design of the next generation of training. The literature search strategy allowed the inclusion of 68 articles. RESULTS Findings of the articles showed that multiple factors shape clinical communication: the functions and effects of information provision, the relational and interactional aspects of communication, its patient- and context-related dimensions, and the intrapsychic and context-related barriers hampering the patient encounter that clinicians are facing. CONCLUSION A way to reach all oncologists and to provide training centred on the singular needs of participants is a shift in the focus of training from communication tasks or communication-related situations to the clinician. PRACTICE IMPLICATIONS Training should focus on the competencies and qualities to be developed by clinicians, such as being flexible, able to adapt to the singular patient, sensitive to interactional aspects of communication, which influence the clinical encounter.
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Affiliation(s)
- Friedrich Stiefel
- Psychiatric Liaison Service, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Céline Bourquin
- Psychiatric Liaison Service, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
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22
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Roider-Schur S, Rumpold T, Kirchheiner K, Masel EK, Nemecek R, Amering M, Watzke H, Schrank B. Migrate your mind: the role of palliative care in transcultural cancer treatment : A qualitative analysis. Wien Klin Wochenschr 2019; 131:191-199. [PMID: 30997564 PMCID: PMC6520309 DOI: 10.1007/s00508-019-1474-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 02/15/2019] [Indexed: 12/02/2022]
Abstract
Background In increasingly multi-ethnic societies fostering cultural awareness and integration of immigrants is not only a political duty but also an obligation for social and healthcare systems. Importantly, cultural beliefs and needs strongly impact on the quality of life of cancer patients and may become even more crucial at the end of life. However, to date, ethnic and cultural aspects of palliative care are insufficiently researched. Methods This qualitative study at the Medical University of Vienna included 21 staff members from different disciplines in oncology and palliative care working with patients with various cultural backgrounds at the end of life. Semi-structured interviews were performed to gain insights into specific aspects of palliative care that are important in the clinical encounter with terminally ill cancer patients with migrant backgrounds and their relatives. Results Interviews revealed specific aspects of palliative care, which fell into four fundamental categories and were all perceived as beneficial in the clinical encounter with migrant clients: (A) structural and (B) personal conditions of the palliative care setting, (C) specific care and treatment intentions and (D) personnel requirements and attitudes. Conclusion This study revealed first insights into possibilities and prospects of transcultural palliative care for migrants and their relatives. The results might have important implications for the end of life care in this growing population.
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Affiliation(s)
- Sophie Roider-Schur
- Clinical Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. .,Clinical Division of Oncology, Department of Internal Medicine I, Sankt Josef Hospital Vienna, Auhofstraße 189, 1130, Vienna, Austria.
| | - Tamara Rumpold
- Clinical Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.,Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Kathrin Kirchheiner
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Eva Katharina Masel
- Clinical Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Romina Nemecek
- Department of Dermatology and Tropical Medicine, Military Medical Cluster East, Austrian Armed Forces, Vienna, Austria
| | - Michaela Amering
- Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Herbert Watzke
- Clinical Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Beate Schrank
- Department of Psychiatry and Psychotherapy, University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
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Broom A, Parker RB, Kirby E, Kokanović R, Woodland L, Lwin Z, Koh ES. A qualitative study of cancer care professionals' experiences of working with migrant patients from diverse cultural backgrounds. BMJ Open 2019; 9:e025956. [PMID: 30904870 PMCID: PMC6475197 DOI: 10.1136/bmjopen-2018-025956] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To improve the experiences of people from diverse cultural backgrounds, there has been an increased emphasis on strengthening cultural awareness and competence in healthcare contexts. The aim of this focus-group based study was to explore how professionals in cancer care experience their encounters with migrant cancer patients with a focus on how they work with cultural diversity in their everyday practice, and the personal, interpersonal and institutional dimensions therein. DESIGN This paper draws on qualitative data from eight focus groups held in three local health districts in major metropolitan areas of Australia. Participants were health professionals (n=57) working with migrants in cancer care, including multicultural community workers, allied health workers, doctors and nurses. Focus group discussions were audio recorded and transcribed in full. Data were analysed using the framework approach and supported by NVivo V.11 qualitative data analysis software. RESULTS Four findings were derived from the analysis: (1) culture as merely one aspect of complex personhood; (2) managing culture at the intersection of institutional, professional and personal values; (3) balancing professional values with patient values and beliefs, and building trust and respect; and (4) the importance of time and everyday relations for generating understanding and intimacy, and for achieving culturally competent care. CONCLUSIONS The findings reveal: how culture is often misconstrued as manageable in isolation; the importance of a renewed emphasis on culture as interpersonal and institutional in character; and the importance of prioritising the development of quality relationships requiring additional time and resource investments in migrant patients for enacting effective intercultural care.
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Affiliation(s)
- Alex Broom
- Centre for Social Research in Health, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Rhiannon Bree Parker
- Centre for Social Research in Health, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Emma Kirby
- Centre for Social Research in Health, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Renata Kokanović
- Social and Global Studies Centre, RMIT University, Melbourne, Victoria, Australia
- Monash Centre for Health Research and Innovation, Monash University, Melbourne, Victoria, Australia
| | - Lisa Woodland
- Multicultural Health Service, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Zarnie Lwin
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Medical Oncology, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Eng-Siew Koh
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
- Department of Radiation Oncology, Liverpool Hospital, Sydney, New South Wales, Australia
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Abstract
Introduction: The purpose of this study was to describe basic palliative care from the acute care nurses' perspective with consideration for culturally diverse populations. Participants focused their responses based on their experiences with Hmong patients. The concept of cultural safety was explored to improve basic palliative care practice in acute care settings. Method: A qualitative approach was utilized. Thirty-four nurses participated in either focus group or individual interviews. Results: Assisting tradition, understanding culture, and managing language barriers were identified as themes unique to providing basic palliative care to Hmong patients. Discussion: Nurses experienced uncertainty and inadequacy of resources when caring for patients from a Hmong background. Nurses also recognized the strong family ties in this specific population and the importance of supporting tradition while in the hospital. Utilizing Wood and Schwass' framework of cultural safety could guide nurses providing basic palliative care to Hmong patients and other culturally diverse patients.
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Affiliation(s)
- Tammy Neiman
- Minnesota State University Mankato, Mankato, MN, USA
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25
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Siler S, Mamier I, Winslow BW, Ferrell BR. Interprofessional Perspectives on Providing Spiritual Care for Patients With Lung Cancer in Outpatient Settings. Oncol Nurs Forum 2019; 46:49-58. [PMID: 30547964 PMCID: PMC7008957 DOI: 10.1188/19.onf.49-58] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To explore palliative care and oncology clinicians' perspectives on current challenges and facilitating factors in meeting the spiritual needs of patients with lung cancer and family caregivers. This study was conducted in preparation for a community-based lung cancer palliative care intervention. PARTICIPANTS & SETTING 19 oncology and palliative care clinicians in three outpatient Kaiser Permanente sites in southern California. METHODOLOGIC APPROACH This multisite qualitative study used focus group and key informant interviews. Data were analyzed using content analysis methodology, and a team approach was used to validate findings. FINDINGS Clinicians described facilitating factors (interprofessional team support, assessment of spiritual needs, clinician-provided spiritual support, and provision of culturally respectful spiritual care) and challenges (related to providing culturally respectful spiritual care by respecting the patients' spiritual and cultural beliefs in an open way and in advocating for the patients' wishes) they encountered when addressing patient and caregiver spiritual needs. IMPLICATIONS FOR NURSING This study demonstrated the need to provide nurses with practical tools, education, and a supportive environment to address patients' and family caregivers' spiritual concerns.
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Cain CL, Surbone A, Elk R, Kagawa-Singer M. Culture and Palliative Care: Preferences, Communication, Meaning, and Mutual Decision Making. J Pain Symptom Manage 2018; 55:1408-1419. [PMID: 29366913 DOI: 10.1016/j.jpainsymman.2018.01.007] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 01/11/2018] [Accepted: 01/12/2018] [Indexed: 01/11/2023]
Abstract
Palliative care is gaining acceptance across the world. However, even when palliative care resources exist, both the delivery and distribution of services too often are neither equitably nor acceptably provided to diverse population groups. The goal of this study was to illustrate tensions in the delivery of palliative care for diverse patient populations to help clinicians to improve care for all. We begin by defining and differentiating culture, race, and ethnicity, so that these terms-often used interchangeably-are not conflated and are more effectively used in caring for diverse populations. We then present examples from an integrative literature review of recent research on culture and palliative care to illustrate both how and why varied responses to pain and suffering occur in different patterns, focusing on four areas of palliative care: the formation of care preferences, communication patterns, different meanings of suffering, and decision-making processes about care. For each area, we provide international and multiethnic examples of variations that emphasize the need for personalization of care and the avoidance of stereotyping beliefs and practices without considering individual circumstances and life histories. We conclude with recommendations for improving palliative care research and practice with cultural perspectives, emphasizing the need to work in partnerships with patients, their family members, and communities to identify and negotiate culturally meaningful care, promote quality of life, and ensure the highest quality palliative care for all, both domestically and internationally.
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Affiliation(s)
- Cindy L Cain
- Department of Health Policy and Management, University of California-Los Angeles, Los Angeles, California.
| | - Antonella Surbone
- Department of Medicine, Division of Haematology and Medical Oncology, New York University Medical School, New York, New York
| | - Ronit Elk
- College of Nursing, University of South Carolina, Columbia, South Carolina
| | - Marjorie Kagawa-Singer
- Department of Community Health Sciences and Asian American Studies Center, University of California-Los Angeles, Los Angeles, California
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