Withholding/Withdrawing Life-Sustaining Treatment in a Multiethnic Critical Care Setting: An Ethnographic Study

Views on advance care planning of family members of older adults with Turkish and Moroccan backgrounds: An exploratory interview study

BACKGROUND

Significantly fewer individuals with migration backgrounds than native-born individuals undertake advance care planning. Older adults with Turkish and Moroccan backgrounds represent one of the largest ageing non-Western minority groups in Europe. Their relatives could play important roles in facilitating or hindering advance care planning, but their views remain underexplored.

AIM

To explore advance care planning knowledge, experience, views, facilitators and barriers among older Turkish and Moroccan adults' relatives in Belgium.

DESIGN

Qualitative thematic analysis of semi-structured interview data.

SETTING/PARTICIPANTS

Twenty-two relatives of older Turkish and Moroccan adults in Brussels, Mechelen and Antwerp, recruited via general practitioners.

RESULTS

Participants had limited advance care planning knowledge and had not discussed it with healthcare professionals. Some found discussing end-of-life preferences with relatives beneficial; others opposed the discussion of specific topics or felt discussions were unnecessary, as they felt responsible for caregiving and trusted by their relatives to make future decisions. Barriers included personal and relational characteristics, emotional difficulty and perceived non-urgency. Facilitators included information in older adults' native languages, general practitioners' cautious initiation and the involvement of several family members.

CONCLUSIONS

Relatives of older people with Turkish and Moroccan backgrounds are unfamiliar with advance care planning and have highly variable views on it. People should be given opportunities to discuss advance care planning in a culturally appropriate manner, and the diversity of perspectives regarding whether and how to engage in such planning should be recognised.ClinicalTrials.gov no. NCT05241301.

Tackling organ donation among minority ethnic communities in the UK-a whole systems approach

INTRODUCTION

There are inequalities experienced by minority ethnic groups in the UK in organ donation and transplant services, with significant variation in relation to demand for, access to and waiting times for these services.

SOURCES OF DATA

A narrative review of research obtained via several databases, including PubMed and Medline, was conducted.

AREAS OF AGREEMENT

A vision of equity and inclusion, which meets the need of the heterogeneous UK population, can only be realized by adopting a culturally competent approach to systems-wide working in organ donation in four core areas-transplant services; workforce and staff training; diversity and inclusion research; and public engagement.

AREAS OF CONTROVERSY

Most of the data on the background of organ donors and recipients use general categories such as Asian or Black. We need to progress to a position of more granular data by more specific ethnicity so that we can better understand the trends and target action accordingly.

GROWING POINTS

By positively embracing the heterogeneity of the UK population, demand for transplantation can be reduced through a sustained commitment to public health interventions and culturally competent approaches in the management of long-term conditions.

AREAS TIMELY FOR DEVELOPING RESEARCH

Improved access to transplantation and reduced waiting times can be achieved to increase the number of organ donors from minority ethnic groups if there are concerted and adequately resourced culturally competent interventions with concomitant evaluation programmes.

Perception, knowledge and attitudes on advance medical directives among hospital staff: Using mixed methodology

BACKGROUND

It is necessary to examine the level of perception, knowledge and attitudes of the medical staff for advance medical directives, which are practical alternatives to good practice for end-of-life care in the actual medical field.

PURPOSE

This study was conducted to determine the degree of perception, knowledge and attitude of cancer hospital medical staff about advance medical directives, and to confirm the relationship between them. It also explored their experiences with advance medical directives.

METHODS

This study used a convergent design to collect quantitative and qualitative data separately in the mixed methodology. This design adheres to the STROBE guidelines. Participants were a total of 140 subjects (70 doctors and 70 nurses) with more than 3 years and considered to have sufficient experience related to the study purpose. Focus group participants were a total 19 persons (9 doctors and 10 nurses).

RESULTS

Mean score for perception was 35.40, which indicates lower perception when compared to the median value (37.50 points). Perception of advance medical directives had significant, positive relations with attitude of advance medical directives (p = .032). The perception on attitude of advance medical directives factor was significantly influencing (p = .021). As a result of the analysis based on qualitative research questions, six subjects and 11 categories were created by deriving meaningful sentences from the statements.

CONCLUSION

This study suggests that the perception of medical professionals about advance medical directives has a positive correlation with attitudes, as well as a causal relationship.

RELEVANCE TO CLINICAL PRACTICE

Based on the finding from this study, concrete strategies and interventions to improve the perception of advance medical directives among cancer hospital medical staff are needed.