'He's telling us something'

Approaches for enhancing patient-reported experience measurement with ethnically diverse communities: a rapid evidence synthesis

BACKGROUND

Patient-reported experience measures (PREMs) are used to drive and evaluate unit and organisational-level healthcare improvement, but also at a population level, these measures can be key indicators of healthcare quality. Current evidence indicates that ethnically diverse communities frequently experience poorer care quality and outcomes, with PREMs data required from this population to direct service improvement efforts. This review synthesises evidence of the methods and approaches used to promote participation in PREMs among ethnically diverse populations.

METHODS

A rapid evidence appraisal (REA) methodology was utilised to identify the disparate literature on this topic. A search strategy was developed and applied to three major electronic databases in July 2022 (Medline; PsycINFO and CINAHL), in addition to websites of health agencies in Organisation for Economic Co-operation and Development countries via grey literature searches. A narrative evidence synthesis was undertaken to address the review question.

RESULTS

The review resulted in 97 included studies, comprised 86 articles from electronic database searches and 11 articles from the grey literature. Data extraction and synthesis identified five strategies used in PREM instruments and processes to enhance participation among ethnically diverse communities. Strategies applied sought to better inform communities about PREMs, to create accessible PREMs instruments, to support PREMs completion and to include culturally relevant topics. Several methods were used, predominantly drawing upon bicultural workers, translation, and community outreach to access and support communities at one or more stages of design or administration of PREMs. Limited evidence was available of the effectiveness of the identified methods and strategies. PREMs topics of trust, cultural responsiveness, care navigation and coordination were identified as pertinent to and frequently explored with this population.

CONCLUSIONS

The findings provide a basis for a maturity model that may guide change to increase participation of ethnically diverse communities in PREMs. In the short-medium term, health systems and services must be able to recognise and respond to cultural and linguistic diversity in the population when applying existing PREMs. In the longer-term, by working in collaboration with ethnically diverse communities, systems and services may co-create adapted or novel PREMs that tackle the factors that currently inhibit uptake and completion among ethnically diverse communities.

"It doesn't exist…": negotiating palliative care from a culturally and linguistically diverse patient and caregiver perspective

Background

The end of life represents a therapeutic context that acutely raises cultural and linguistic specificities, yet there is very little evidence illustrating the importance of such dynamics in shaping choices, trajectories and care practices. Culture and language interplay to offer considerable potential challenges to both patient and provider, with further work needed to explore patient and caregiver perspectives across cultures and linguistic groups, and provider perspectives. The objective of this study was to develop a critical, evidence-based understanding of the experiences of people from Culturally and Linguistically Diverse (CALD) backgrounds, and their caregivers, in a palliative care setting.

Methods

A qualitative study, using semi-structured interviews to explore key experiences and perspectives of CALD patients and caregivers currently undergoing treatment under oncology or palliative care specialists in two Australian hospitals. Interviews were digitally audio recorded and transcribed in full. A thematic analysis was conducted utilising the framework approach.

Results

Sixteen patients and fourteen caregivers from a range of CALD backgrounds participated in semi-structured interviews. The research identified four prevalent themes among participants: (1) Terminology in the transition to palliative care; (2) Communication, culture and pain management; (3) (Not) Talking about death and dying; and, (4) Religious faith as a coping strategy: challenging the terminal diagnosis.

Conclusions

CALD patients and caregivers’ experiences are multifaceted, particularly in negotiating linguistic difficulties, beliefs about treatment, and issues related to death and dying. Greater attention is needed to develop effective communication skills, recognise CALD patients’ particular cultural, linguistic and spiritual values and needs, and acknowledge the unique nature of each doctor-patient interaction.

Cancer

Previous work in the anthropology of cancer often examined causes, risks, and medical, familial, and embodied relationships created by the disease. Recent writing has expanded that focus, attending to cancer as a “total social fact” ( Jain 2013 ) and dissecting the landscape of “carcinogenic relationships” ( Livingston 2012 ). Cancer-driven relationships become subjectively real through individual suffering, stigma, and inequality. This article traces concepts developed from a primarily US-centered discourse to a global cancer discourse, including cancer-related issues continuing to raise concern such as stigma, narrative moments of critical reflection on the dominance of biomedicine, and processes by which individuals and communities manage inadequate access to biomedical technologies. Beyond the medical relations and politics of cancer, this article considers the ways in which ethnography addresses local moral worlds and differences that come to matter in attending to the disease, the person, and consequent social and material relations.

"Researcher saturation": the impact of data triangulation and intensive-research practices on the researcher and qualitative research process

Theoretically and methodologically sound qualitative research demands an extended period of fieldwork and the use of multiple methods to achieve data saturation and develop the grounded theory. Little is known about the experiences of researchers who conduct such studies. The authors explore these matters by drawing on their experiences of conducting a 3-year qualitative study with women about their gynecological cancer journey. Their fieldwork consisted of participant observation and in-depth interviews with women and health professionals. They demonstrate that researchers who are involved in all phases of emotionally demanding research; that is, data collection (recruiting, observing, expanding field notes, and interviewing), transcription, and data analysis repeatedly relive difficult events, which might potentially compromise the researchers' well-being and, in turn, the research process and data validity. The authors discuss how researchers can deal effectively with these matters during fieldwork and propose a more formal approach to debriefing.

Discourses of normality and difference: Responses to diagnosis and treatment of gynaecological cancer of Australian women

By comparison to other cancers such as breast and lung cancer, women in Australia are relatively infrequently diagnosed with gynaecological cancers. Apart from cervical cancer, public health information on gynaecological cancer is limited, as are published stories from gynaecological cancer survivors in women's magazines. Our qualitative study investigated how women with gynaecological cancers develop an identity in relation to their illness, and examined the extent of, and reasons for, a sense of perceived difference. The study was conducted between 2001 and 2003 and included in-depth interviews with 52 women aged 27-80 years diagnosed with gynaecological cancer within the past 5 years. Our analysis illustrates how women draw on a wider cancer discourse to make sense of their own illness, which gave them a sense of commonality. However, some women, predominantly those who were diagnosed with cancer of the vulva or vagina, or who underwent particular uncommon or unfamiliar treatments such as brachytherapy, had difficulties situating their illness within the wider cancer discourse. This had implications for women when accessing social support.

Maternal identity change as a consequence of antenatal hospitalization

Despite low fertility rates in Western countries, maternity remains one of the major goals of women from various socioeconomic backgrounds. While most women will have low-risk pregnancies, common serious disorders of pregnancy, such as preeclampsia, premature rupture of the membranes, placenta previa, or fetal growth restriction, may compromise maternal and infant outcomes. The experiences of urban and rural women in Australia who have had difficulties in maintaining their pregnancies are analyzed in this article. We study the impact of individual and social factors that facilitate or impede women's adjustment to the risks associated with these disorders. The analysis of in-depth interviews with 27 women hospitalized antenatally indicates that most women were unfamiliar with the diagnoses and acted as passive "decision takers," complying with medical advice to remain in the hospital. Admission to a tertiary hospital ward that provided care to women with pregnancy disorders promoted the formation of a new identity, that of a woman whose pregnancy did not follow the expected path. Further, hospitalization offered women the opportunity to interact with others in similar difficult situations and, hence, feel less isolated.

Complementary medicine use by Australian women with gynaecological cancer

AIMS AND OBJECTIVES

Social and cultural factors are identified that impact on complementary therapy use among Australia-born and immigrant women diagnosed with gynaecological cancer.

METHODS

A qualitative study design including in-depth interviews with women diagnosed with gynaecological cancer (N=53) and participant observation was conducted.

RESULTS

Approximately one-third of women utilized complementary and alternative medicine, with this being determined by current health concerns and health beliefs related to the efficacy of different modalities. Four types of complementary therapy users emerged: consequential, therapeutic, informed and exploratory.

CONCLUSION

There was a relatively low uptake of complementary treatments. Choice was influenced by women's socio-demographic background, clinical and personal history, lack of personal experiences of gynaecological cancer among study participants' kin and friends, and lack of popular alternative literature on such cancer.

“Like roulette”: Australian women's explanations of gynecological cancers

Drawing on data from interviews and other ethnographic research, we examine how Australian women from different ethnic and cultural backgrounds make sense of having gynecological cancer. Alternative explanatory models often co-exist in a single narrative, but there is significant consistency in the etiology of cancer among Australian-born and immigrant women. In acknowledging the unpredictability of cancer and the prognosis of particular disease, women contextualize their own experience as a matter of luck, outside their control or influence. Most often women relate their own occurrence of cancer to their social setting and relational factors rather than personal behavior, but at the same time, they acknowledge the interaction of external forces and individual factors, particularly in the case of diet and stress. Women can control diet to some extent, although many note the irony of having developed cancer even when they have eaten well. Stress, on the other hand, is largely considered as external to and beyond women's control. Women speak of stress as a characteristic of contemporary social life, as well as their own public and domestic, physical and emotional lives; for these women stress in any of these areas can create physical vulnerability that may result in cancer. Since women associate cancer with loss of control, the idea of cancerous cells out-of-control within their bodies operates as a metonym of women's views of themselves interpersonally and socially.