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Piracha NZ, Nickel LB, Quryshi A, Salah R, Padela AI. Muslims and End-of-Life Healthcare in Non-Muslim Majority Nations: A Systematic Literature Review. J Pain Symptom Manage 2024; 67:e299-e312. [PMID: 38218412 PMCID: PMC10939778 DOI: 10.1016/j.jpainsymman.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 12/08/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024]
Abstract
CONTEXT As Muslim populations in non-Muslim majority nations grow and age, they will increasingly require culturally appropriate healthcare. Delivering such care requires understanding their experiences with, as well as preferences regarding, end-of-life healthcare. OBJECTIVES To examine the experiences, needs, and challenges of Muslim patients and caregivers with end-of-life, hospice, and palliative care. METHODS A systematic literature review using five databases (MEDLINE, Scopus, Web of Science, CINAHL, Cochrane Library) and key terms related to Islam and end-of-life healthcare. Papers were limited to English-language empirical studies of adults in non-Muslim majority nations. After removing duplicates, titles, abstracts, and articles were screened for quality and reviewed by a multidisciplinary team. RESULTS From an initial list of 1867 articles, 29 articles met all inclusion criteria. Most studies focused on end-of-life healthcare not related to palliative or hospice services and examined Muslim patient and caregiver experiences rather than their needs or challenges. Content analysis revealed three themes: (1) the role of family in caregiving as a moral duty and as surrogate communicators; (2) gaps in knowledge among providers related to Muslim needs and gaps in patient/family knowledge about advance care planning; and (3) the influence of Islam on Muslim physicians' perspectives and practices. CONCLUSION There is scant research on Muslim patients' and caregivers' engagement with end-of-life healthcare in non-Muslim majority nations. Existing research documents knowledge gaps impeding both Muslim patient engagement with end-of-life care and the delivery of culturally appropriate healthcare.
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Affiliation(s)
- Natasha Z Piracha
- Division of Critical Care and Hospital Medicine, Department of Pediatrics (N.Z.P.), Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, New York, USA; Adult Palliative Care Service, Department of Medicine (N.Z.P.), Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, New York, USA
| | - Lauren B Nickel
- Department of Emergency Medicine (L.B.N., A.Q., A.I.P.), Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
| | - Afiya Quryshi
- Department of Emergency Medicine (L.B.N., A.Q., A.I.P.), Medical College of Wisconsin, Milwaukee, Wisconsin, USA; Harvard University (A.Q.), Cambridge, Massachusetts, USA
| | - Ramy Salah
- Department of Palliative Medicine (R.S.), Palo Alto Medical Foundation, San Mateo, California, USA
| | - Aasim I Padela
- Department of Emergency Medicine (L.B.N., A.Q., A.I.P.), Medical College of Wisconsin, Milwaukee, Wisconsin, USA; Initiative on Islam and Medicine (A.I.P.), Glendale Heights, Illinois, USA
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Velić S, Qama E, Diviani N, Rubinelli S. Patients' perception of hope in palliative care: A systematic review and narrative synthesis. PATIENT EDUCATION AND COUNSELING 2023; 115:107879. [PMID: 37413808 DOI: 10.1016/j.pec.2023.107879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE The aim of this study was to systematically review and synthesize the literature on patients' perceptions of hope in palliative care. METHODS PubMed, Scopus, SocINDEX, Cochrane, and Web of Science were screened against the eligibility criteria. After familiarization with the data and conduction of the coding process, studies were thematically analyzed using Braun and Clarke's methodology. The research question guiding our analysis was: what is said about hope from patients in PC? RESULTS The database searches yielded 24 eligible studies. Three main themes emerged from the studies: Hope beliefs (encompassing patients' understanding of hope and characteristics assigned to it), Hope functions (including the role that hope plays for patients) and Hope work (highlighting aspects that in patients' perspective cultivate hope). CONCLUSION This review emphasizes the importance of acknowledging patients' understanding of hope, its role, and the efforts required to sustain it. In particular, it suggests that hope serves as a valuable strategy, fostering meaningful personal relationships towards end of life. PRACTICE IMPLICATIONS In order to address communication challenges in clinical practice, a potential fruitful strategy for nurturing hope could involve engaging family and friends in hope interventions facilitated by healthcare professionals.
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Affiliation(s)
- Sanda Velić
- Swiss Paraplegic Research, Person-centered Healthcare & Health Communication Group, Guido A. Zäch Strasse 4, 6207 Nottwil, Switzerland; Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland
| | - Enxhi Qama
- Swiss Paraplegic Research, Person-centered Healthcare & Health Communication Group, Guido A. Zäch Strasse 4, 6207 Nottwil, Switzerland; Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland
| | - Nicola Diviani
- Swiss Paraplegic Research, Person-centered Healthcare & Health Communication Group, Guido A. Zäch Strasse 4, 6207 Nottwil, Switzerland; Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland
| | - Sara Rubinelli
- Swiss Paraplegic Research, Person-centered Healthcare & Health Communication Group, Guido A. Zäch Strasse 4, 6207 Nottwil, Switzerland; Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland.
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Higher overall admittance of immigrants to specialised palliative care in Denmark: a nationwide register-based study of 99,624 patients with cancer. Support Care Cancer 2023; 31:132. [PMID: 36695904 PMCID: PMC9875181 DOI: 10.1007/s00520-023-07597-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/16/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND The population of immigrants in Europe is ageing. Accordingly, the number of immigrants with life-threatening diseases and need for specialised palliative care will increase. In Europe, immigrants' admittance to specialised palliative care is not well explored. AIM To investigate whether country of origin was associated with admittance to (I) palliative care team/unit, (II) hospice, and/or (III) specialised palliative care, overall (i.e. palliative care team/unit and/or hospice). DESIGN Data sources for the population cohort study were the Danish Palliative Care Database and several nationwide registers. We investigated the associations between country of origin and admittance to specialised palliative care, overall, and to type of palliative care using logistic regression analyses. SETTING/PARTICIPANTS In 2010-2016, 104,775 cancer patients died in Denmark: 96% were born in Denmark, 2% in other Western countries, and 2% in non-Western countries. RESULTS Overall admittance to specialised palliative care was higher for immigrants from other Western (OR = 1.13; 95%CI: 1.03-1.24) and non-Western countries (OR = 1.22; 95%CI: 1.08-1.37) than for the majority population. Similar results were found for admittance to palliative care teams. No difference in admittance to hospice was found for immigrants from other Western countries (OR = 1.04; 95%CI: 0.93-1.16) compared to the majority population, while lower admittance was found for non-Western immigrants (OR = 0.70; 95%CI: 0.60-0.81). CONCLUSION Admittance to specialised palliative care was higher for immigrants than for the majority population as higher admittance to palliative care teams for non-Western immigrants more than compensated for the lower hospice admittance. This may reflect a combination of larger needs and that hospital-based and home-based services are perceived as preferable by immigrants.
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Broholm-Jørgensen M. The practice of hope in public health interventions: a qualitative single-case study. Health Promot Int 2022; 37:6749047. [DOI: 10.1093/heapro/daac144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Summary
This study examines hope practices in the context of participation in a public health intervention. Theoretically, the study builds upon Cheryl Mattingly’s notion of hope as a practice, which renders the possibility of examining participants actions, interactions and challenges with participating. This analytical lens contributes knowledge about how interventions are incorporated into participants’ hopes for a future life and the consequences of intervening in peoples’ everyday lives. The study builds on empirical material from a pilot study of the primary preventive intervention known as TOF (Tidlig Opsporing og Forebyggelse—a Danish acronym for ‘Early Detection and Prevention’) which aimed to identify high risk individuals and provide targeted preventive services. A by-product of a larger qualitative study, itself based on the TOF pilot study in 2019, this single-case study illustrates how participants’ life situation influence how they interpret and manage activities in a public health intervention. The study shows how the practice of hope in public health interventions is closely linked to participants’ own interpretations of how participation can lead to a life worth living. The findings, which show that participants’ needs, and life situation influence the ways in which they respond to an intervention, adds to the complexity in intervention research. Further, the study illustrates some of the ethical challenges that arise when researchers intervene in people’s everyday life. It reinforces the need for ongoing critical reflection and attention to be directed at how those being studied articulate and practice hope.
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Affiliation(s)
- Marie Broholm-Jørgensen
- National Institute of Public Health, Research Program on Health and Social Conditions, University of Southern Denmark , Copenhagen , Denmark
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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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Abdullah R, Guo P, Harding R. Preferences and Experiences of Muslim Patients and Their Families in Muslim-Majority Countries for End-of-Life Care: A Systematic Review and Thematic Analysis. J Pain Symptom Manage 2020; 60:1223-1238.e4. [PMID: 32659320 DOI: 10.1016/j.jpainsymman.2020.06.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 05/26/2020] [Accepted: 06/19/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Care for people with progressive illness should be person centered and account for their cultural values and spiritual beliefs. There are an estimated 1.7 billion Muslims worldwide, largely living in low-income and middle-income countries. AIMS This study aimed to identify, appraise, and integrate the evidence for the experiences and preferences of Muslim patients and/or families for end-of-life care in Muslim-majority countries. DESIGN Systematic review. DATA SOURCES PsychINFO, MEDLINE, Embase, Global Health, CINAHL, Cochrane Library and Registry of Clinical Trials, PubMed, Applied Social Sciences Index and Abstracts (ASSIA), Social Services Abstracts, Sociological Abstracts, Social Policy & Practice, and Scopus were searched until December 2018. Handsearching was performed, and gray literature was included. Qualitative studies analyzed using thematic analysis and quantitative component provided triangulation. RESULTS The initial search yielded n = 5098 articles, of which n = 30 met the inclusion criteria. A total of 5342 participants (4345 patients; 81.3%) were included; 97.6% had advanced cancer. Most (n = 22) studies were quantitative. Three themes and subthemes from qualitative studies were identified using thematic analysis: selflessness (burden to others and caregiver responsibilities), ambivalence (hope and hopelessness), and strong beliefs in Islam (beliefs in death and afterlife and closeness to Allah). Qualitative studies reported triangulation; demonstrating conflicts in diagnosis disclosure and total pain burden experienced by both patients and families. CONCLUSION Despite the scarce evidence of relatively low quality, the analysis revealed core themes. To achieve palliative care for all in line with the total pain model, beliefs must be identified and understood in relation to decision-making processes and practices.
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Affiliation(s)
- Rafidah Abdullah
- Hospital Sultan Haji Ahmad Shah, Ministry of Health, Temerloh, Malaysia.
| | - Ping Guo
- University of Birmingham, Cicely Saunders Institute, Kings College London, London United Kingdom
| | - Richard Harding
- Cicely Saunders Institute, Kings College London, London, United Kingdom
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Malas E, Chaar B, Krayem G. End-of-life treatment decisions in adult Muslims: a scoping review protocol. JBI Evid Synth 2020; 18:1528-1536. [PMID: 32813392 DOI: 10.11124/jbisrir-d-19-00270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this scoping review is to explore the empirical evidence on the range of treatment decisions made by adult Muslims at the end of life. INTRODUCTION Relief of pain and suffering is a human right; however, ethnic, racial, and religious minorities do not receive optimum end-of-life care. Several factors have been identified as impacting on the decision-making of minority populations. These patients have been found to access palliative care to a lesser degree, receive inadequate pain management, prefer aggressive care, and die in a place other than their place of preference. Muslims remain an under-represented community in end-of-life studies, with little known about their care preferences and decisions in their final stage of life. INCLUSION CRITERIA This review will include studies whose participants are adults (≥18 years) facing end-of-life decision-making who identify as Muslim while residing in a non-Muslim-majority country. The participants may be healthy volunteers with a view on the subject, or patients and their caregivers facing end-of-life decision-making. Quantitative and qualitative studies will be included, with the exclusion of theoretical and opinion-based articles. METHODS The three-step search strategy for the proposed scoping review will follow JBI methodology. Databases to be searched include MEDLINE via OvidSP, PsycINFO via OvidSP, Embase via OvidSP, Scopus (Elsevier), CINAHL via EBSCO, and ProQuest Dissertations and Theses Global. Studies in English published since database inception will be considered. The results will be extracted and charted by two independent reviewers. Data will be presented in tabular form and a narrative summary provided.
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Affiliation(s)
- Emna Malas
- 1School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia 2Sydney Law School, University of Sydney, Sydney, Australia
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Mosley DV, Neville HA, Chavez‐Dueñas NY, Adames HY, Lewis JA, French BH. Radical hope in revolting times: Proposing a culturally relevant psychological framework. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2019. [DOI: 10.1111/spc3.12512] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Della V. Mosley
- Department of PsychologyUniversity of Florida Gainesville Florida
| | - Helen A. Neville
- Department of Educational Psychology and African American StudiesUniversity of Illinois at Urbana‐Champaign Champaign Illinois
| | | | - Hector Y. Adames
- Counseling PsychologyThe Chicago School of Professional Psychology Chicago Illinois
| | - Jioni A. Lewis
- Department of PsychologyUniversity of Tennessee Knoxville Tennessee
| | - Bryana H. French
- Graduate School of Professional PsychologyUniversity of St. Thomas Minneapolis Minnesota
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Abstract
Hope is a universal humanuniverse living experience. To advance nursing knowledge of hope as a universal humanuniverse living experience, the scholar dwelled with printed material on hope and explored with pattern preferences. The purpose of this paper is to set forth the conceptual foreknowings arising from the integrative review of literature from diverse disciplines. Four themes arose from the review, which are elaborated here.
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Affiliation(s)
- Mi Jin Doe
- Decker School of Nursing, Binghamton University, Binghamton, NY, USA
- State University of New York
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10
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Clyne B, O'Neill SM, Nuzum D, O'Neill M, Larkin J, Ryan M, Smith SM. Patients' spirituality perspectives at the end of life: a qualitative evidence synthesis. BMJ Support Palliat Care 2019; 12:e550-e561. [PMID: 31771958 DOI: 10.1136/bmjspcare-2019-002016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/15/2019] [Accepted: 11/04/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Understanding patient perceptions of their spiritual needs when approaching the end of life is essential to support the delivery of patient-centred care. AIM To conduct a qualitative evidence synthesis on spirituality and spiritual care needs at the end of life in all healthcare settings from the patients' perspective. DESIGN Studies were included where they were primary qualitative studies exploring spirituality in patients with a life expectancy of 12 months or less in any setting. Two reviewers independently screened titles, extracted data and conducted methodological quality appraisal. A thematic synthesis was conducted. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) - Confidence in the Evidence from Reviews of Qualitative research (CERQual) was used to summarise the certainty of the evidence. DATA SOURCES Six databases (Medline, Embase, Cochrane, CINAHL, PsycINFO, Applied Social Science Index and Abstracts) were searched from inception up to January 2019. RESULTS Fifty papers (42 unique datasets), incorporating data from 710 patients were included. Studies recruited from a mix of inpatient, outpatient, hospice and community settings across 12 different countries. Three overarching themes were generated: the concept of spirituality, spiritual needs and distress, and spiritual care resources. Relationships were an intrinsic component of spirituality. CONCLUSION Meeting patients' spiritual needs is an integral part of end-of-life care. This work emphasises that supporting relationships should be a central focus of spiritual care for patients at the end of life. PROSPERO REGISTRATION NUMBER CRD42019122062.
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Affiliation(s)
- Barbara Clyne
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland .,Health Research Board - Collaboration in Ireland for Clinical Effectiveness Reviews (HRB-CICER), Health Information and Quality Authority Dublin Regional Office, Dublin, Ireland
| | - Sinead M O'Neill
- Health Research Board - Collaboration in Ireland for Clinical Effectiveness Reviews (HRB-CICER), Health Information and Quality Authority Dublin Regional Office, Dublin, Ireland
| | - Daniel Nuzum
- Pastoral Care Department, Marymount University Hospital and Hospice, Cork, Ireland.,Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland
| | - Michelle O'Neill
- Health Research Board - Collaboration in Ireland for Clinical Effectiveness Reviews (HRB-CICER), Health Information and Quality Authority Dublin Regional Office, Dublin, Ireland
| | - James Larkin
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Máirín Ryan
- Health Research Board - Collaboration in Ireland for Clinical Effectiveness Reviews (HRB-CICER), Health Information and Quality Authority Dublin Regional Office, Dublin, Ireland
| | - Susan M Smith
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland.,Health Research Board - Collaboration in Ireland for Clinical Effectiveness Reviews (HRB-CICER), Health Information and Quality Authority Dublin Regional Office, Dublin, Ireland
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Abstract
AbstractObjectiveSouth Asian migrants have a higher burden of life-threatening diseases and chronic diseases compared to other ethnic groups. Yet, knowledge gaps remain around their palliative care needs in the host countries. The aim of the review was to present results from a systematic literature review of available international evidence on experiences with and perspectives on palliative care among older South Asian migrants, relatives, and healthcare providers.MethodsA systematic review in accordance with PRISMA guidelines was conducted in February 2018, searching PubMed, CINAHL, PsychINFO, and EMBASE databases. PROSPERO #CRD42018093464. Studies included empirical research, providing international evidence on experiences and perspectives on palliative care of South Asian migrants and were published between 2000 and 2018. Thematic synthesis was used to analyze data.ResultsA total of 30 articles were included: qualitative (24), quantitative (5), and mixed methods (1). Three main themes were discovered: 1) palliative care practice within the family, 2) trust as a precondition of palliative care, and 3) the importance of knowledge and cultural competency. All the themes, to a greater or lesser extent, are related to access to and use of palliative care services by South Asian migrant families.Significance of resultsInvolvement of family members in palliative care decision making could improve the satisfaction of South Asian migrant families toward the service. For example, Advanced Care Planning involving family members could be a possible way to engage family members in palliative care decision making. Supportive interventions, e.g. providing knowledge, aimed at patients and their family members might improve knowledge and increase awareness among South Asian migrant families of palliative care. Knowledge gained from this review could be implemented with other ethnic minority groups.
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Ahaddour C, Van den Branden S, Broeckaert B. Between quality of life and hope. Attitudes and beliefs of Muslim women toward withholding and withdrawing life-sustaining treatments. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2018; 21:347-361. [PMID: 29043540 DOI: 10.1007/s11019-017-9808-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The technological advances in medicine, including prolongation of life, have constituted several dilemmas at the end of life. In the context of the Belgian debates on end-of-life care, the views of Muslim women remain understudied. The aim of this article is fourfold. First, we seek to describe the beliefs and attitudes of middle-aged and elderly Moroccan Muslim women toward withholding and withdrawing life-sustaining treatments. Second, we aim to identify whether differences are observable among middle-aged and elderly women's attitudes toward withholding and withdrawing life-sustaining treatments. Third, we aim to explore the role of religion in their attitudes. Fourth, we seek to document how our results are related to normative Islamic literature. Qualitative empirical research was conducted with a sample of middle-aged and elderly Moroccan Muslim women (n = 30) living in Antwerp (Belgium) and with experts in the field (n = 15). We found an unconditional belief in God's sovereign power over the domain of life and death (cf. determined lifespan by God) and in God's almightiness (cf. belief in a miracle). However, we also found a tolerant attitude, mainly among our middle-aged participants, toward withholding and withdrawing (treatment) based on theological, eschatological, financial and quality of life arguments. Our study reveals that religious beliefs and worldviews have a great impact on the ethical attitudes toward end-of-life issues. We found divergent positions toward withholding and withdrawing life-sustaining treatments, reflecting the lines of reasoning found in normative Islamic literature. In our interviews, theological and eschatological notions emerged as well as financial and quality of life arguments.
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Affiliation(s)
- Chaïma Ahaddour
- Faculty of Theology and Religious Studies (Research Unit of Theological and Comparative Ethics), KU Leuven, Sint-Michielsstraat 6, 3000, Leuven, Belgium.
| | - Stef Van den Branden
- Faculty of Theology and Religious Studies (Research Unit of Theological and Comparative Ethics), KU Leuven, Sint-Michielsstraat 6, 3000, Leuven, Belgium
| | - Bert Broeckaert
- Faculty of Theology and Religious Studies (Research Unit of Theological and Comparative Ethics), KU Leuven, Sint-Michielsstraat 6, 3000, Leuven, Belgium
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Affiliation(s)
- Werner Nell
- Optentia Research Focus Area, North-West University, Vanderbijlpark, South Africa
| | - Sebastiaan Rothmann
- Optentia Research Focus Area, North-West University, Vanderbijlpark, South Africa
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Finucane AM, Carduff E, Lugton J, Fenning S, Johnston B, Fallon M, Clark D, Spiller JA, Murray SA. Palliative and end-of-life care research in Scotland 2006-2015: a systematic scoping review. BMC Palliat Care 2018; 17:19. [PMID: 29373964 PMCID: PMC5787303 DOI: 10.1186/s12904-017-0266-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 12/12/2017] [Indexed: 11/22/2022] Open
Abstract
Background The Scottish Government set out its 5-year vision to improve palliative care in its Strategic Framework for Action 2016–2021. This includes a commitment to strengthening research and evidence based knowledge exchange across Scotland. A comprehensive scoping review of Scottish palliative care research was considered an important first step. The aim of the review was to quantify and map palliative care research in Scotland over the ten-year period preceding the new strategy (2006–15). Methods A systematic scoping review was undertaken. Palliative care research involving at least one co-author from a Scottish institution was eligible for inclusion. Five databases were searched with relevant MeSH terms and keywords; additional papers authored by members of the Scottish Palliative and End of Life Care Research Forum were added. Results In total, 1919 papers were screened, 496 underwent full text review and 308 were retained in the final set. 73% were descriptive studies and 10% were interventions or feasibility studies. The top three areas of research focus were services and settings; experiences and/or needs; and physical symptoms. 58 papers were concerned with palliative care for people with conditions other than cancer – nearly one fifth of all papers published. Few studies focused on ehealth, health economics, out-of-hours and public health. Nearly half of all papers described unfunded research or did not acknowledge a funder (46%). Conclusions There was a steady increase in Scottish palliative care research during the decade under review. Research output was strong compared with that reported in an earlier Scottish review (1990–2005) and a similar review of Irish palliative care research (2002–2012). A large amount of descriptive evidence exists on living and dying with chronic progressive illness in Scotland; intervention studies now need to be prioritised. Areas highlighted for future research include palliative interventions for people with non-malignant illness and multi-morbidity; physical and psychological symptom assessment and management; interventions to support carers; and bereavement support. Knowledge exchange activities are required to disseminate research findings to research users and a follow-up review to examine future research progress is recommended. Electronic supplementary material The online version of this article (10.1186/s12904-017-0266-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne M Finucane
- Marie Curie Hospice Edinburgh, 45 Frogston Road West, Edinburgh, EH10 7DR, UK. .,Centre for Population Health Sciences, The Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK.
| | - Emma Carduff
- Marie Curie Hospice Glasgow, 133 Balornock Road, Glasgow, G21 3US, UK.,School of Medicine, Nursing and Healthcare, University of Glasgow, 59 Oakfield Avenue, Glasgow, G12 8LL, UK
| | - Jean Lugton
- Marie Curie Hospice Edinburgh, 45 Frogston Road West, Edinburgh, EH10 7DR, UK
| | - Stephen Fenning
- Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK
| | - Bridget Johnston
- Florence Nightingale Foundation, Clinical Nursing Practice Research, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow and NHS Greater Glasgow and Clyde, 57-61 Oakfield Avenue, Glasgow, G12 8LL, UK
| | - Marie Fallon
- Institute of Genetics and Palliative Medicine, University of Edinburgh, Western General Hospital, Edinburgh, EH4 2XR, UK
| | - David Clark
- School of Interdisciplinary Studies, University of Glasgow, Bankend Road, Dumfries, DG1 4ZL, UK
| | - Juliet A Spiller
- Marie Curie Hospice Edinburgh, 45 Frogston Road West, Edinburgh, EH10 7DR, UK
| | - Scott A Murray
- Centre for Population Health Sciences, The Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
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Ahaddour C, Van den Branden S, Broeckaert B. "God is the giver and taker of life": Muslim beliefs and attitudes regarding assisted suicide and euthanasia. AJOB Empir Bioeth 2018; 9:1-11. [PMID: 29267141 DOI: 10.1080/23294515.2017.1420708] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In the context of the Belgian debates on end-of-life care, the views of Muslims remain understudied. The aim of this article is twofold. First, we seek to document the relation between contemporary normative Muslim ideas on assisted suicide and voluntary euthanasia on the one hand and real-world views and attitudes of Muslims living in Belgium on the other hand. Second, we aim to identify whether a shift is observable in the views and attitudes regarding active termination of life between first- and second-generation Muslims. We have observed that when dealing with these bioethical issues, both first- and second-generation Muslims adopt a theological line of reasoning similar to the one that can be found in normative Islamic views. We have found an absolute rejection of every act that deliberately terminates life, based upon the unconditional belief in an afterlife and in God's sovereign power over life and death.
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Affiliation(s)
- Chaïma Ahaddour
- a Faculty of Theology and Religious Studies, KU Leuven (Research Unit of Theological and Comparative Ethics) , Leuven , Belgium
| | - Stef Van den Branden
- a Faculty of Theology and Religious Studies, KU Leuven (Research Unit of Theological and Comparative Ethics) , Leuven , Belgium
| | - Bert Broeckaert
- a Faculty of Theology and Religious Studies, KU Leuven (Research Unit of Theological and Comparative Ethics) , Leuven , Belgium
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16
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Emadian A, England CY, Thompson JL. Dietary intake and factors influencing eating behaviours in overweight and obese South Asian men living in the UK: mixed method study. BMJ Open 2017; 7:e016919. [PMID: 28729327 PMCID: PMC5541587 DOI: 10.1136/bmjopen-2017-016919] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE It is widely recognised that South Asian men living in the UK are more likely to develop type 2 diabetes mellitus (T2DM) than their white British counterparts. Despite this, limited data have been published quantifying current dietary intake patterns and qualitatively exploring eating behaviours in this population. The objectives of this study were to (1) assess diet, (2) explore perceptions of T2DM, (3) investigate factors influencing eating behaviours in overweight/obese South Asian men and (4) determine the suitability of the UK Diet and Diabetes Questionnaire (UKDDQ) for use in this population. SETTING Community-based setting in the Greater London, UK area. PARTICIPANTS South Asian men aged 18-64 years, with a body mass index of over 23.0 kg/m2, not previously diagnosed with T2DM. METHODS A cross-sectional mixed-methods design, including assessment of dietary intake using UKDDQ (n=63), followed by semistructured interviews in a purposive sample (n=36). RESULTS UKDDQ scores indicated 54% of participants had a 'healthy' diet with a mean sample score of 3.44±0.43 out of a maximum of 5. Oily fish consumption was low (1.84±1.85). Body weight was positively associated with a high-added sugar subscore (r=0.253, p=0.047), with 69.8% of the men having 'unhealthy' intakes of sugar-sweetened beverages. Cultural commitments (eg, extended family and faith events), motivation and time were identified as key barriers to dietary change, with family support an important facilitator to making healthy dietary changes. Participants stated that UKDDQ was suitable for assessing diets of South Asians and made suggestions for tailoring questions related to rice consumption, providing examples of Indian sweets, and including ghee as a fat source. CONCLUSION Many of the areas of dietary improvement and factors affecting eating behaviours identified in this study are similar to those observed in the general UK population. Consumption of sugar-sweetened beverages in particular was high; given the association between their consumption and the risk of T2DM, this should be an area of primary focus for healthcare professionals. Nevertheless, there are sociocultural factors unique to this population that need to be considered when designing culturally specific programs to reduce the development of T2DM in this high-risk population.
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Affiliation(s)
- Amir Emadian
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Clare Y England
- Centre for Exercise, Nutrition and Health Sciences, University of Bristol, Bristol, UK
- Bristol Biomedical Research Unit in Nutrition, Diet and Lifestyle, National Institute for Health Research, University Hospitals Bristol Education and Research Centre, Bristol, UK
| | - Janice L Thompson
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Kristiansen M, Razum O, Tezcan-Güntekin H, Krasnik A. Aging and health among migrants in a European perspective. Public Health Rev 2016; 37:20. [PMID: 29450062 PMCID: PMC5809957 DOI: 10.1186/s40985-016-0036-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 10/05/2016] [Indexed: 11/10/2022] Open
Abstract
Population aging and the associated changes in demographic structures and healthcare needs is a key challenge across Europe. Healthy aging strategies focus on ensuring the ability to maintain health, quality of life and independent living at old age. Concurrent to the process of population aging, the demographics of Europe are affected by increased migration resulting in substantial ethnic diversity. In this paper, we narratively review the health profile of the growing proportion of aging migrants in Europe, outline key factors shaping health among this diverse group and consider ways of addressing their healthcare needs. Although factors shaping aging processes are largely similar across populations, migrant-specific risk factors exist. These include exposure to health risks before and during migration; a more disadvantaged socioeconomic position; language barriers and low health literacy; cultural factors influencing health-seeking behaviours; and psychosocial vulnerability and discrimination affecting health and quality of life. Overall, migrants experience the same morbidity and mortality causes as the native populations, but with different relative importance, severity and age of onset and with substantial differences within and between migrant groups. Little is known regarding health behaviours among aging migrants, although differences in cancer screening behaviours have been identified. Indications of widening health differentials between migrants and native populations with age and informal barriers to quality healthcare for aging migrants are causes of concern. In conclusion, there is a need for attention to migration alongside other determinants of healthy aging. The diversity in individual characteristics, life course processes and contextual factors shaping aging processes among migrants point to the need for a sensitive and comprehensive approach to policies, practices and research within the field of healthy aging. This is important to accommodate for the needs of the growing number of aging migrants in Europe and counter inequities in health and well-being at old age.
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Affiliation(s)
- Maria Kristiansen
- 1Center for Healthy Aging (CEHA), Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Oliver Razum
- 2Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Hürrem Tezcan-Güntekin
- 2Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Allan Krasnik
- 1Center for Healthy Aging (CEHA), Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,3Danish Research Center for Migration, Ethnicity and Health (MESU), Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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18
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Fang ML, Sixsmith J, Sinclair S, Horst G. A knowledge synthesis of culturally- and spiritually-sensitive end-of-life care: findings from a scoping review. BMC Geriatr 2016; 16:107. [PMID: 27193395 PMCID: PMC4872365 DOI: 10.1186/s12877-016-0282-6] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 05/11/2016] [Indexed: 11/23/2022] Open
Abstract
Background Multiple factors influence the end-of-life (EoL) care and experience of poor quality services by culturally- and spiritually-diverse groups. Access to EoL services e.g. health and social supports at home or in hospices is difficult for ethnic minorities compared to white European groups. A tool is required to empower patients and families to access culturally-safe care. This review was undertaken by the Canadian Virtual Hospice as a foundation for this tool. Methods To explore attitudes, behaviours and patterns to utilization of EoL care by culturally and spiritually diverse groups and identify gaps in EoL care practice and delivery methods, a scoping review and thematic analysis of article content was conducted. Fourteen electronic databases and websites were searched between June–August 2014 to identify English-language peer-reviewed publications and grey literature (including reports and other online resources) published between 2004–2014. Results The search identified barriers and enablers at the systems, community and personal/family levels. Primary barriers include: cultural differences between healthcare providers; persons approaching EoL and family members; under-utilization of culturally-sensitive models designed to improve EoL care; language barriers; lack of awareness of cultural and religious diversity issues; exclusion of families in the decision-making process; personal racial and religious discrimination; and lack of culturally-tailored EoL information to facilitate decision-making. Conclusions This review highlights that most research has focused on decision-making. There were fewer studies exploring different cultural and spiritual experiences at the EoL and interventions to improve EoL care. Interventions evaluated were largely educational in nature rather than service oriented. Electronic supplementary material The online version of this article (doi:10.1186/s12877-016-0282-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mei Lan Fang
- Gerontology Research Centre, Simon Fraser University, 2800-515 West Hastings Street, Vancouver, BC, V6B 5 K3, Canada.
| | - Judith Sixsmith
- Institute of Health and Wellbeing, University of Northampton, Northampton, UK.,School of Public Policy, Simon Fraser University, Vancouver, BC, Canada
| | - Shane Sinclair
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada.,Hospice Clinical Team, Canadian Virtual Hospice, Winnipeg, MB, Canada
| | - Glen Horst
- Hospice Clinical Team, Canadian Virtual Hospice, Winnipeg, MB, Canada
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Edwards TM, Jovanovski A. Hope as a Therapeutic Target in Counselling – In General and in Relation to Christian Clients. INTERNATIONAL JOURNAL FOR THE ADVANCEMENT OF COUNSELLING 2016. [DOI: 10.1007/s10447-016-9257-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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20
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Jensen AMB. "Make Sure Somebody Will Survive from This": Transformative Practices of Hope among Danish Organ Donor Families. Med Anthropol Q 2016; 30:378-94. [PMID: 26768160 DOI: 10.1111/maq.12278] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Based on anthropological fieldwork among Danish organ donor families and hospital staff in neurointensive care units, this article explores the transformative practices of hope in Danish organ donation. Focusing on various phases of the organ donation process, I demonstrate how families and professionals practice hope in astounding ways: when hoping for organs, when hoping for the end of patient suffering, when hoping for the usability of the donor body, and when hoping to help future donor families by sharing painful experiences. By focusing on such practices and transformations of hope, this article sheds light on the social negotiations of life and death among families and staffs in medical contexts and describes how the dignity of the deceased donor and the usability of the donor body are closely connected in family attempts to make donation decisions meaningful during and after a tragic death.
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Affiliation(s)
- Anja M B Jensen
- Centre for Medical Science and Technology Studies, Department of Public Health, University of Copenhagen
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21
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Michaëlis C, Kristiansen M, Norredam M. Quality of life and coping strategies among immigrant women living with pain in Denmark: a qualitative study. BMJ Open 2015; 5:e008075. [PMID: 26163036 PMCID: PMC4499741 DOI: 10.1136/bmjopen-2015-008075] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 06/10/2015] [Accepted: 06/22/2015] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To examine quality of life and coping strategies among immigrant women living with chronic pain. DESIGN Qualitative content analysis based on in-depth semistructured interviews. SETTING A clinic specifically targeting immigrants at a larger university hospital in Copenhagen, Denmark. PARTICIPANTS Non-western female immigrant patients suffering from chronic pain (n=13). MAIN OUTCOME MEASURES Experiences of the impact of chronic pain on quality of life. RESULTS Chronic pain was perceived to have an extensive, adverse effect on all aspects of quality of life, including physical health, mental well-being and social relations. This included the ability to maintain activities of daily living and the ability to work. Chronic pain was further experienced as a cause of emotional distress, depression and altered personalities, which all had great consequences on women's social interactions, causing change and loss of social relations. A variety of coping strategies were used to cope with the pain, manage its consequences, and restore a level of health that would enable women to function and fulfil social roles. Many participants coped with the pain by altering everyday life, keeping daily activities to a minimum and taking pain-killing drugs, offering temporary relief. Seeking healthcare was another coping strategy used as an active means to assert agency and as a temporary distraction from pain. However, accessing healthcare also involved a risk of disagreement and disappointments. CONCLUSIONS Chronic pain had a severe negative impact on quality of life and necessitated alterations in everyday life and active health-seeking strategies. Implications for practice imply a need for a more holistic approach to immigrant women with chronic pain, including a family-centred approach. Further research is needed to explore similarities or differences in and between populations with diverse ethnic, socioeconomic and psychosocial backgrounds, and to assess how ethnicity and culture might influence the experiences of chronic pain.
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Affiliation(s)
- Camilla Michaëlis
- Section of Immigrant Medicine, Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| | - Maria Kristiansen
- Department of Public Health, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
- Department of Public Health, Danish Research Center for Migration, Ethnicity and Health, University of Copenhagen, Copenhagen, Denmark
| | - Marie Norredam
- Section of Immigrant Medicine, Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Public Health, Danish Research Center for Migration, Ethnicity and Health, University of Copenhagen, Copenhagen, Denmark
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22
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A singing choir: Understanding the dynamics of hope, hopelessness, and despair in palliative care patients. A longitudinal qualitative study. Palliat Support Care 2015; 13:1643-50. [PMID: 25912395 DOI: 10.1017/s147895151500019x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Hope, despair, and hopelessness are dynamic in nature; however, they have not been explored over time. The objective of the present study was to describe hope, hopelessness, and despair over time, as experienced by palliative care patients. METHOD We employed a qualitative longitudinal method based on narrative theories. Semistructured interviews with palliative care patients were prospectively conducted, recorded, and transcribed. Data on hope, hopelessness and despair were thematically analyzed, which led to similarities and differences between these concepts. The concepts were then analyzed over time in each case. During all stages, the researchers took a reflexive stance, wrote memos, and did member checking with participants. RESULTS A total of 29 palliative care patients (mean age, 65.9 years; standard deviation, 14.7; 14 females) were included, 11 of whom suffered from incurable cancer, 10 from severe chronic obstructive pulmonary disease, and 8 from severe heart failure. They were interviewed a maximum of three times. Participants associated hope with gains in the past or future, such as physical improvement or spending time with significant others. They associated hopelessness with past losses, like loss of health, income, or significant others, and despair with future losses, which included the possibility of losing the future itself. Over time, the nature of their hope, hopelessness, and despair changed when their condition changed. These dynamics could be understood as voices in a singing choir that can sing together, alternate with each other, or sing their own melody. SIGNIFICANCE OF RESULTS Our findings offer insight into hope, hopelessness, and despair over time, and the metaphor of a choir helps to understand the coexistence of these concepts. The findings also help healthcare professionals to address hope, hopelessness, and despair during encounters with patients, which is particularly important when the patients' physical condition has changed.
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Gaveras EM, Kristiansen M, Worth A, Irshad T, Sheikh A. Social support for South Asian Muslim parents with life-limiting illness living in Scotland: a multiperspective qualitative study. BMJ Open 2014; 4:e004252. [PMID: 24503303 PMCID: PMC3918973 DOI: 10.1136/bmjopen-2013-004252] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 01/07/2014] [Accepted: 01/14/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To explore experiences of social support needs among South Asian Muslim patients with life-limiting illness, living in Scotland, who are parents of young children. DESIGN Secondary analysis of data from a multiperspective, longitudinal Scottish study involving in-depth semistructured interviews with patients, their nominated carers and healthcare professionals. Data were analysed using interpretive phenomenological analysis. SETTING Edinburgh, Scotland. PARTICIPANTS South-Asian Muslim patients with life-limiting illness with children under the age of 18 (n=8), their carer (n=6) and their healthcare professional. MAIN OUTCOME MEASURES Access and provision of social support in palliative care. RESULTS Open-ended qualitative interviews identified four main themes: (1) parental sadness over being unable to provide tangible support; (2) parental desire to continue to provide emotional support; (3) limited availability of informal social support networks; and (4) differing perspectives between healthcare professionals and patients on patient access to social support sources, with a subtheme being the capacity of male carers to provide social support. South-Asian parents at the end of life had limited access to extended-network support. Gender roles appeared as challenging for healthcare providers who at times overestimated the amount of support a female carer could provide and underestimated the amount of support male carers provided. Implications for practice include the need for greater awareness by healthcare providers of the social support needs of ethnic minority and migrant parents with life-limiting illnesses and especially an awareness of the importance of the role of male and female carers. Further research is needed to explore how the timing of migration impacts the need for and availability of tangible and emotional informal social support among ethnic minority parents with life-limiting illness.
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Affiliation(s)
- Eleni Margareta Gaveras
- Danish Research Centre for Migration, Ethnicity and Health, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | - Maria Kristiansen
- Danish Research Centre for Migration, Ethnicity and Health, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
- Health Sciences Department, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Allison Worth
- Primary Palliative Care Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
| | - Tasneem Irshad
- Primary Palliative Care Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
| | - Aziz Sheikh
- Primary Palliative Care Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
- Harkness Fellow in Health Care Policy and Practice, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA
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